Do blacks, Hispanics, and the poor get poorer medical care?
The intuitive answer is yes, and in fact previous literature (see this paper, for example) seems to support this assertion. But a new article in the New England Journal of Medicine claims to show the opposite. Say the authors of the new article: "Previous studies have focused on a narrow set of quality indicators and conditions in selected populations and have had a limited ability to adjust for the range of factors associated with poorer quality. Few studies have examined quality across the continuum of care for multiple conditions."
The paper by Asch et al., then, seeks to estimate whether the care actually received by the subjects in their study population correspond to a set of indicators of ideal care. The indicator set is available here as a PDF, in a working paper from RAND (the authors' institution).
Surprisingly, the authors estimate that the population overall received 55 percent of recommend care -- that is, we're all not getting the care we should be. Even more surprising was the finding that quality of care varied only slightly among racial and socioeconomic groups.
The authors conclude, "Quality-improvement programs that focus solely on reducing disparities among sociodemographic subgroups may miss larger opportunities to improve care. "
This is probably the case. But their results should not be accepted uncritically, for two important reasons.
1. Abysmal response rate. The authors included in the study "all persons for whom [they] had at least one record (37 percent of the eligible sample). " Of course, the authors performed sensitivity analyses (in lay terms: estimating what difference the response rate might have had on the calculated results) and constructed models which controlled for non-response. They say, for example, "For nonresponse by blacks [in this study] to have produced the magnitude of disparities commonly found in previous studies, nonrespondent blacks would need to have had implausibly low (near zero) quality scores." Whether this is implausible is open to question, I think.
The study also excluded people who don't have a telephone and who saw no health-care provider during the previous two years. Obviously, these are the poorest of the poor.
2. Quality by what measure? The quality indicators used in this study come from a variety of sources: randomized trials together with consensus statements by professional societies. Furthermore, we don't know whether these quality indicators correspond to decreases in morbidity or mortality.
Despite these weaknesses, this is a highly important result. And I can comment, based on my limited personal experience, that it rings true. Errors are widespread. I have seen the poor get the same care as the very rich, and I have seen both failed by the system.
3/16/06
Doc, I'm breathing funny!
Funny peculiar, or funny ha-ha?
In this week's New England Journal, Rachel Sobel, a medical writer and fourth-year medical student at UCSF, has a thought-provoking piece about humor in the medical workplace. When young doctors loosen up in private, patients are often the butt of their jokes. This helps to shore up doctors' sanity in a stressful environment, but corrodes the dignity of the sick and the doctor-patient relationship.
Funny peculiar, or funny ha-ha?
In this week's New England Journal, Rachel Sobel, a medical writer and fourth-year medical student at UCSF, has a thought-provoking piece about humor in the medical workplace. When young doctors loosen up in private, patients are often the butt of their jokes. This helps to shore up doctors' sanity in a stressful environment, but corrodes the dignity of the sick and the doctor-patient relationship.
The medical teams convened for a ritual snack break at 10:45 on a recent call night. We ate our ice cream in the far corner of the Moffiteria — as we affectionately call the cafeteria at UCSF's Moffit–Long Hospital — fueling up before the onslaught of admissions. The evening's theme: funniest beeper pages in the middle of the night.
"I once got this page from a nurse," said an intern. "`Doctor, your patient is covered in ants.'" The table erupted in laughter. Apparently, the patient had come in off the streets and brought the ants with him. They crawled out from their hiding spots after the doctor had done the initial workup. Another hilarious page: "Doctor, your patient is on fire." The man in question was psychiatrically unstable and had ignited himself. We were howling in between spoonfuls of ice cream.
[. . .]
In retrospect, I realized that during that night in the Moffiteria, I had, strictly speaking, violated a central tenet of the professionalism contract, which states: "I will treat patients and their families with respect and dignity, both in their presence and in discussions with other members of the health care team." We had been laughing at the patients and their misfortune. They were the butt of the joke, their dignity violated. But they were also the ultimate reason why I had endured the rigors of training thus far — and why staying up late studying had been a labor of love. In hindsight, laughing seemed a bit like betrayal.
Why, then, in those few seconds of juvenile hilarity, did I not feel an ounce of guilt? Perhaps it was simply that being with a group of other medical "professionals" made it seem okay. Or maybe it was justified because laughing brought us together as a team in an important bonding moment, which would ultimately benefit our patients. Or perhaps laughing was less about making fun of patients and more about coping, finding humor in a day filled with suffering. We were witnessing more darkness in our 20s than many other people see in a lifetime.
3/12/06
If you can hear the sound of my voice, have a drink
And a snack.
Would that I could give shalekhmones to everyone I know. Until that day, this Purim poem, included in every bag of raisins and hamentaschen, will have to do. (Yiddish and Hebrew versions here.)
And a snack.
Would that I could give shalekhmones to everyone I know. Until that day, this Purim poem, included in every bag of raisins and hamentaschen, will have to do. (Yiddish and Hebrew versions here.)
Pain brings redemption
Unless it doesn’t.
Reason to celebrate
Isn’t Their defeat.
My survival’s not the why of it.
Proper partying has a drive
Unbound to past suffering,
Reactive but not visceral.
I say we get drunk now –
Maybe just a little bit.
Prepare a list of our demands.
Upthrusting sugar-sticky fists,
Rage against the Maker.
Importune the Deity for
Moral strength, lawful rigor, smooth-burning whiskey, tasty cookies.
Reason to celebrate
Isn’t Their defeat.
My survival’s not the why of it.
Proper partying has a drive
Unbound to past suffering,
Reactive but not visceral.
I say we get drunk now –
Maybe just a little bit.
Prepare a list of our demands.
Upthrusting sugar-sticky fists,
Rage against the Maker.
Importune the Deity for
Moral strength, lawful rigor, smooth-burning whiskey, tasty cookies.
3/9/06
Of Three or Four People
Yehuda Amichai
Of three or four people at dinner
You're always sat next to the nudnik
Forced to hear about the neighbor's overgrown garden,
The uncollected trash on the hills
Lit by the soft golden stone
Paid for by the extortionate taxes
Of the municipality
Of Jerusalem.
And people who left for fifteen minutes
Come back in thirty, when dinner is cold.
Of three or four people at dinner
One always finishes his soup
But feels it's rude to ask for more.
He stares into the bowl.
Within him: hunger. For soup,
For peace, for Biblical passion
Tamely modernized. For language
Common, tasty and cozy
Like this soup
Which can no longer be ladled out
Since it has been eaten already
By you, and the main course
Still unserved.
Yehuda Amichai
Of three or four people at dinner
You're always sat next to the nudnik
Forced to hear about the neighbor's overgrown garden,
The uncollected trash on the hills
Lit by the soft golden stone
Paid for by the extortionate taxes
Of the municipality
Of Jerusalem.
And people who left for fifteen minutes
Come back in thirty, when dinner is cold.
Of three or four people at dinner
One always finishes his soup
But feels it's rude to ask for more.
He stares into the bowl.
Within him: hunger. For soup,
For peace, for Biblical passion
Tamely modernized. For language
Common, tasty and cozy
Like this soup
Which can no longer be ladled out
Since it has been eaten already
By you, and the main course
Still unserved.
3/6/06
Morality, homosexuality, and halachah
Fumblings toward a thought or two, in pseudo-axiomatic form.
1.1. The issue of homosexuality within (or without) halachah can be viewed in many ways. One can start with the relevant halachot and work from them "towards" the sociological reality of homosexuality -- that is to say, in a strictly constructionist vein, find those heterim [legal allowances] which might make it possible for the acknowledgment of homosexuality (not homosexual behavior itself) to exist within a halachic community. This assumes that the halachot are applicable, and that moral considerations are either (a) only intra-halachic, i.e. generated by the halachic system, or (b) never applicable to the halachic system even when generated from without.
1.1.1. Halachot are generally applicable. To be a halachically observant Jew means that there is a very strong presumption that the halachah applies in the case at hand. What the halachah is in a given case -- i.e. how that is to be determined -- is very complicated from a general point of view, and I won't go into that here.
1.1.2. There are cases in which the halachah is not applicable. Whether there is a general formulation of all such cases is beyond the scope of this blog. There is an argument among the poskim [halachic decisors] whether every state of affairs can be addressed by halachah, or whether there are some states of affairs which are halachically irrelevant.
1.1.3. Moral considerations are important for determining whether halachah applies in a given case. In opposition to R. David Halivni, for example, I believe that our halachic predecessors (Chazal) did operate with explicit moral criteria. Many of these criteria are explicit (tikkun ha-olam, for one), while others are obscured by literary style. Thus we would not be the first to use moral criteria for evaluating halachah. Whether such "firstness" is relevant is another question.
1.1.4. How moral considerations and halachah interact is not simple. There are some cases in which the moral reality has changed from what was held true according to the halachah as it stands.
1.1.5. Such changes in moral reality do not always require halachic attention.
1.1.6. When large classes of people, by virtue of their wholly moral actions, are regarded as "extra-halachic," or sinners, this requires halachic attention.
1.1.7. Note that 1.1.6. does not apply to egalitarianism, which should be defended on other grounds.
1.1.7. "Halachic attention" entails, among other things, a deliberation whether the halachah as it stands is consonant with the moral reality that we know to be the case.
1.2. Similarly, one could start with the premise that homosexuality is immoral, either because (as noted above) halachic prohibitions establish such immorality by their very existence, or the immorality of homosexuality is a fact of the matter independent of halachah.(Rabbi Joel Roth makes use of both these arguments in his teshuvah.) By this account, halachah would serve either as a guarantor of (heterosexual) morality, or a bar to homosexual behavior which is ipso facto immoral.
2.1. Adult, loving, consensual homosexual relationships are to be morally valued, i.e. are the opposite of immoral.
2.1.1. One can quarrel with 2.1., but this is not a place to rehash the arguments made elsewhere against such spurious claims as the following: homosexuals weaken heterosexual marriage; homosexuals weaken a society's moral fiber; homosexuals are sexually perverse.
2.2. A considerable minority of Jews are gays and lesbians. By 1.1.6., since the halachah as it stands considers them as sinners, liberal poskim (to whom this discussion is confined) should consider the matter closely.
2.3. The halachic ramifications of homosexuality are many, but at the root lies the de-oraita (Torah-level) prohibition of "lying with a man [as one does with a woman]," i.e. anal sexual relations.
2.3.1. Sexual relations are at the heart of a loving, consensual, adult relationship. There are sexual acts proper to heterosexuals and there are those proper to homosexuals. And, of course, there are those which overlap.
2.3.2. The moral dissonance caused by the halachic prohibition of homosexuality does not extend merely to later outgrowths of the Torah's prohibition, i.e. to "recognizing" gay-and-lesbian couples, or the like. Rather, it goes to the very root of the matter, to the prohibition of "lying with a man as one does with a woman."
2.4. A morally based halachic change must take into account the prohibition of anal sex.
Fumblings toward a thought or two, in pseudo-axiomatic form.
1.1. The issue of homosexuality within (or without) halachah can be viewed in many ways. One can start with the relevant halachot and work from them "towards" the sociological reality of homosexuality -- that is to say, in a strictly constructionist vein, find those heterim [legal allowances] which might make it possible for the acknowledgment of homosexuality (not homosexual behavior itself) to exist within a halachic community. This assumes that the halachot are applicable, and that moral considerations are either (a) only intra-halachic, i.e. generated by the halachic system, or (b) never applicable to the halachic system even when generated from without.
1.1.1. Halachot are generally applicable. To be a halachically observant Jew means that there is a very strong presumption that the halachah applies in the case at hand. What the halachah is in a given case -- i.e. how that is to be determined -- is very complicated from a general point of view, and I won't go into that here.
1.1.2. There are cases in which the halachah is not applicable. Whether there is a general formulation of all such cases is beyond the scope of this blog. There is an argument among the poskim [halachic decisors] whether every state of affairs can be addressed by halachah, or whether there are some states of affairs which are halachically irrelevant.
1.1.3. Moral considerations are important for determining whether halachah applies in a given case. In opposition to R. David Halivni, for example, I believe that our halachic predecessors (Chazal) did operate with explicit moral criteria. Many of these criteria are explicit (tikkun ha-olam, for one), while others are obscured by literary style. Thus we would not be the first to use moral criteria for evaluating halachah. Whether such "firstness" is relevant is another question.
1.1.4. How moral considerations and halachah interact is not simple. There are some cases in which the moral reality has changed from what was held true according to the halachah as it stands.
1.1.5. Such changes in moral reality do not always require halachic attention.
1.1.6. When large classes of people, by virtue of their wholly moral actions, are regarded as "extra-halachic," or sinners, this requires halachic attention.
1.1.7. Note that 1.1.6. does not apply to egalitarianism, which should be defended on other grounds.
1.1.7. "Halachic attention" entails, among other things, a deliberation whether the halachah as it stands is consonant with the moral reality that we know to be the case.
1.2. Similarly, one could start with the premise that homosexuality is immoral, either because (as noted above) halachic prohibitions establish such immorality by their very existence, or the immorality of homosexuality is a fact of the matter independent of halachah.
2.1. Adult, loving, consensual homosexual relationships are to be morally valued, i.e. are the opposite of immoral.
2.1.1. One can quarrel with 2.1., but this is not a place to rehash the arguments made elsewhere against such spurious claims as the following: homosexuals weaken heterosexual marriage; homosexuals weaken a society's moral fiber; homosexuals are sexually perverse.
2.2. A considerable minority of Jews are gays and lesbians. By 1.1.6., since the halachah as it stands considers them as sinners, liberal poskim (to whom this discussion is confined) should consider the matter closely.
2.3. The halachic ramifications of homosexuality are many, but at the root lies the de-oraita (Torah-level) prohibition of "lying with a man [as one does with a woman]," i.e. anal sexual relations.
2.3.1. Sexual relations are at the heart of a loving, consensual, adult relationship. There are sexual acts proper to heterosexuals and there are those proper to homosexuals. And, of course, there are those which overlap.
2.3.2. The moral dissonance caused by the halachic prohibition of homosexuality does not extend merely to later outgrowths of the Torah's prohibition, i.e. to "recognizing" gay-and-lesbian couples, or the like. Rather, it goes to the very root of the matter, to the prohibition of "lying with a man as one does with a woman."
2.4. A morally based halachic change must take into account the prohibition of anal sex.
3/2/06
Why Johnny still smokes
Unhealthy behaviors and why we can't stop.
MEDICINE MENSCH: Nobody's Perfect
March 3, 2006
When it comes to our health, we can all be careless. Why do some of us keep smoking when we have relatives who died young from lung cancer and heart disease? Why do we eat like it's going out of style when New York is chock-full of obese diabetics? Why are so many Sabbath tables heavily laden with cholent and challah with nary a fruit or vegetable?
All these behaviors are hard to change; some are even addictive. There's also ample scientific proof that some of them are partially society's fault. It is attractive to smoke when cigarettes are made to seem glamorous. It is hard to eat a healthy diet when the nearest store with fresh fruits and vegetables is 25 blocks away, in the rich people's neighborhood. To take a more familiar example, more and more of us are sedentary and overweight — with the rest of society forced to pick up the slack.
But every year there are many people who stop smoking, and there are others who manage to lose weight, even when all outside factors are stacked against them. Conversely, many of us who keep smoking, drink to excess or eat unwisely aren't doing so under duress. No one is holding a gun to our heads.
What's the cause of our errors in judgment? I don't know. But there are some potential answers.
We don't know any better. Why would someone knowingly behave in a way that has negative consequences? By nature, people strive for the good, one could say, and self-damage is only committed out of ignorance. But after years of intensive health education financed by everyone from the feds to Philip Morris, it's hard to find the untroubled soul who still believes that Marlboros are the doctor's best friend or that obesity is not damaging. Our response to being (re-)informed about the harms of this or that consumption is not a surprised "Oh, really?" but a guilty headshake and a sorrowful "I know, I know! I should stop!" There are those cases — such as in the early years of the AIDS epidemic — in which education makes, or would have made, all the difference, but not when an unhealthful behavior like smoking, poor diet or lack of exercise is already deeply ingrained.
We don't like to think about risks. Many people ride their bikes without a helmet — not because they don't know that helmets prevent injury, and not because they're foolhardy, but because they don't think about it. No one likes to think about car accidents, least of all on a beautiful spring day with the wind in your hair as you fly through Central Park.
That's an oversimplification. We do think about some risks quite a bit: The press has been preoccupied with recent disclosures about the ineffectiveness of the low-fat diet and with the pandemic of influenza among birds. But to use an unpoetic word, we misprioritize. It's not bird flu or fatty foods that are to blame for some of the world's worst and most frequent health problems — it's unwise, widespread behaviors, the consequences of which are easily predictable.
We can't be helped. Somewhere between the naiveté I started with as a medical student (just smile and be friendly, and people will cooperate to make themselves healthy) and the desperation of the cynics ("If there's a problem, it must be the patient's fault") is a disquieting truth. There are some of us who make decisions that doctors would call the wrong ones. Then, when we are involved in a conversation about our own health, given all the information and opportunities we need and provided with dedicated staff, experts in their fields who want nothing more than to help us over the rough patches — then, finally . . . we make exactly the same unwise health decision we made in the first place. Given all the necessary data, we make a different decision than public-health workers would make on our behalf.
Maybe that's because of the reasons I already mentioned: We don't know about the scientific evidence, or we can't appreciate technical discussions of statistical risk. But maybe, in the final analysis, we just don't want to. In other words:
It's out of our hands. We would change, but we can't. Quit bothering us. I don't like to exercise. I enjoy my cigarette. No one likes to be nagged. The more we're talked down to about what we should and shouldn't do, the more difficult it is for someone well meaning to broach the topic — and the more unpleasant it is for us to think about our unwise behaviors in the privacy of our own room. We avoid the issues.
Information is not the cure-all. Educating us to understand the complexities of health risks requires a shift in thinking that could take a couple of generations to take hold. Sometimes our frustrations and defensiveness seem insurmountable. So two choices are left: give up or keep trying.
Not coincidentally, these are the same choices every health-care worker has when trying to help a patient. Obviously there's only one right choice that helps both parties. To keep trying doesn't mean success; it means that patient and doctor show up at least semi-regularly — with ears open and with the hope that, equidistant from their frustrations, lies an understanding of why the other behaves the way he does. If we listen to each other in the doctor's office, maybe we'll all make fewer mistakes. Or at least we'll better understand the mistakes we keep making.
In the next few installments of Medicine Mensch, Zack will complete his last rotation as a medical student, travel to China, and get his M.D. Ask him about anything, or tell him how he's wrong, by writing to doctor@forward.com.
Unhealthy behaviors and why we can't stop.
MEDICINE MENSCH: Nobody's Perfect
March 3, 2006
When it comes to our health, we can all be careless. Why do some of us keep smoking when we have relatives who died young from lung cancer and heart disease? Why do we eat like it's going out of style when New York is chock-full of obese diabetics? Why are so many Sabbath tables heavily laden with cholent and challah with nary a fruit or vegetable?
All these behaviors are hard to change; some are even addictive. There's also ample scientific proof that some of them are partially society's fault. It is attractive to smoke when cigarettes are made to seem glamorous. It is hard to eat a healthy diet when the nearest store with fresh fruits and vegetables is 25 blocks away, in the rich people's neighborhood. To take a more familiar example, more and more of us are sedentary and overweight — with the rest of society forced to pick up the slack.
But every year there are many people who stop smoking, and there are others who manage to lose weight, even when all outside factors are stacked against them. Conversely, many of us who keep smoking, drink to excess or eat unwisely aren't doing so under duress. No one is holding a gun to our heads.
What's the cause of our errors in judgment? I don't know. But there are some potential answers.
We don't know any better. Why would someone knowingly behave in a way that has negative consequences? By nature, people strive for the good, one could say, and self-damage is only committed out of ignorance. But after years of intensive health education financed by everyone from the feds to Philip Morris, it's hard to find the untroubled soul who still believes that Marlboros are the doctor's best friend or that obesity is not damaging. Our response to being (re-)informed about the harms of this or that consumption is not a surprised "Oh, really?" but a guilty headshake and a sorrowful "I know, I know! I should stop!" There are those cases — such as in the early years of the AIDS epidemic — in which education makes, or would have made, all the difference, but not when an unhealthful behavior like smoking, poor diet or lack of exercise is already deeply ingrained.
We don't like to think about risks. Many people ride their bikes without a helmet — not because they don't know that helmets prevent injury, and not because they're foolhardy, but because they don't think about it. No one likes to think about car accidents, least of all on a beautiful spring day with the wind in your hair as you fly through Central Park.
That's an oversimplification. We do think about some risks quite a bit: The press has been preoccupied with recent disclosures about the ineffectiveness of the low-fat diet and with the pandemic of influenza among birds. But to use an unpoetic word, we misprioritize. It's not bird flu or fatty foods that are to blame for some of the world's worst and most frequent health problems — it's unwise, widespread behaviors, the consequences of which are easily predictable.
We can't be helped. Somewhere between the naiveté I started with as a medical student (just smile and be friendly, and people will cooperate to make themselves healthy) and the desperation of the cynics ("If there's a problem, it must be the patient's fault") is a disquieting truth. There are some of us who make decisions that doctors would call the wrong ones. Then, when we are involved in a conversation about our own health, given all the information and opportunities we need and provided with dedicated staff, experts in their fields who want nothing more than to help us over the rough patches — then, finally . . . we make exactly the same unwise health decision we made in the first place. Given all the necessary data, we make a different decision than public-health workers would make on our behalf.
Maybe that's because of the reasons I already mentioned: We don't know about the scientific evidence, or we can't appreciate technical discussions of statistical risk. But maybe, in the final analysis, we just don't want to. In other words:
It's out of our hands. We would change, but we can't. Quit bothering us. I don't like to exercise. I enjoy my cigarette. No one likes to be nagged. The more we're talked down to about what we should and shouldn't do, the more difficult it is for someone well meaning to broach the topic — and the more unpleasant it is for us to think about our unwise behaviors in the privacy of our own room. We avoid the issues.
Information is not the cure-all. Educating us to understand the complexities of health risks requires a shift in thinking that could take a couple of generations to take hold. Sometimes our frustrations and defensiveness seem insurmountable. So two choices are left: give up or keep trying.
Not coincidentally, these are the same choices every health-care worker has when trying to help a patient. Obviously there's only one right choice that helps both parties. To keep trying doesn't mean success; it means that patient and doctor show up at least semi-regularly — with ears open and with the hope that, equidistant from their frustrations, lies an understanding of why the other behaves the way he does. If we listen to each other in the doctor's office, maybe we'll all make fewer mistakes. Or at least we'll better understand the mistakes we keep making.
In the next few installments of Medicine Mensch, Zack will complete his last rotation as a medical student, travel to China, and get his M.D. Ask him about anything, or tell him how he's wrong, by writing to doctor@forward.com.
2/28/06
Carnaval of Consent
The many contradictions of Purim make a remarkable pairing. On the one hand, everything turned topsy-turvy and upside down.
On the other hand, the Jews "affirmed and accepted" the Torah. Why did they accept it then? Shouldn't they have done so at Mount Sinai? See the Babylonian Talmud, Shabbos 88a, which approximates a Rabbinic discussion of consent theory. (For a fuller treatment, see the Jewish Political Tradition, volume 1.)
Many theories can be advanced to explain why the Jews (re-)accepted the Torah after their victory over their Hamanite enemies. But one (certainly not original with me) is that upheaval is a natural setting for affirmation or stock-taking. At the very moment when the Jews thought they might be lost, they found reasons to accept what they might have been disinclined previously to consent to explicitly.
The many contradictions of Purim make a remarkable pairing. On the one hand, everything turned topsy-turvy and upside down.
On the other hand, the Jews "affirmed and accepted" the Torah. Why did they accept it then? Shouldn't they have done so at Mount Sinai? See the Babylonian Talmud, Shabbos 88a, which approximates a Rabbinic discussion of consent theory. (For a fuller treatment, see the Jewish Political Tradition, volume 1.)
Many theories can be advanced to explain why the Jews (re-)accepted the Torah after their victory over their Hamanite enemies. But one (certainly not original with me) is that upheaval is a natural setting for affirmation or stock-taking. At the very moment when the Jews thought they might be lost, they found reasons to accept what they might have been disinclined previously to consent to explicitly.
2/26/06
The poet of hospitals and Divine yearning
Yisroel Shtern: redeemed by the Internet?
Yisroel Shtern (1894-1942?) was a Yiddish poet of Warsaw. The Yisroel Shtern Project, possibly the most attractively designed and easy-to-read Yiddish-English web site now going, aims to present translations of a wide selection of his poetry and prose. (A couple of these translations are by yours truly.)
Everyone thought Shtern an eccentric -- he much preferred davening in the local shtibl than hanging out with fellow literati. To quote the web site:
Yisroel Shtern: redeemed by the Internet?
Yisroel Shtern (1894-1942?) was a Yiddish poet of Warsaw. The Yisroel Shtern Project, possibly the most attractively designed and easy-to-read Yiddish-English web site now going, aims to present translations of a wide selection of his poetry and prose. (A couple of these translations are by yours truly.)
Everyone thought Shtern an eccentric -- he much preferred davening in the local shtibl than hanging out with fellow literati. To quote the web site:
Shtern stands almost alone as one who held in high regard both the secularizing I L Peretz and the traditionalist Hillel Tseitlin ; who frequented both Tlomackie 13 - the secular Yiddish writers' club, where his actor brother was a familiar - and the shtibl of the Bratslaver Chassidim. He adhered to no Party and his work appeared in Bundist and Zionist publications as well as in the Folkist daily Moment.
Other writers thought him strange but valued his work. [. . .] In the Warsaw Ghetto Shtern was starving and Ringelblum's diary records that the community moved him into an apartment at the Kehilla's expense. For that matter Shtern was starving before the War; and did repeatedly write, with authority, about the spiritual aspects of the experience.
While Shtern first published in 1919 and we know that he was writing much in the Ghetto (all of it lost), periods of marked creativity alternate in his life with lengthy periods of silence. He was hospitalized, whether for malnutrition or for a nervous breakdown is unclear. The tone of his work is generally gloomy and sometimes very fearful. Striking and characteristic is the absence of human relationship, together with the personalizing of inanimate features of the city - such as the buildings and the streets where Shtern spent so much of his days, wandering about in a shabby coat with papers poking out of his pockets.
Secular Yiddishism has had difficulty locating Shtern. Yet it is interesting that he chose to adhere to the Bratslaver Chassidim. For it is the oral transcribed Yiddish tales of the Bratslaver that secularists have honoured as among the earliest Yiddish stories. The perspective of the Bratslaver, so foreign to secular socialism, is clear in Shtern's essays and verse: through suffering we are brought closer to God; simple and poor people will be holier. Shtern is very serious about the purpose of literature in general: with Dostoyevsky as a model, to bring the reader to a truer understanding of the relation between life and God.It is more than likely that the continuation of the Yiddish language will depend on observant Jews4. Yisroel Shtern saw himself as a bridge between them and the secular, and sought - as in his great essay Crowns - to introduce Jewish ideas to those without such knowledge. It may be that his relevance is greater now than ever before.
2/22/06
A novelist's intuition
I recently had the pleasure of interviewing Allegra Goodman; stay tuned for my piece in the Forward in which she talks abut her new novel.
I recently had the pleasure of interviewing Allegra Goodman; stay tuned for my piece in the Forward in which she talks abut her new novel.
Theologians argue intelligent design
Karl Giberson, the editor in chief at Science & Theology News, attacked Intelligent Design theory last December. Alvin Plantinga, a philosopher from Notre Dame (the university, not the cathedral), responds:
Exchange filched from Prosblogion.
Karl Giberson, the editor in chief at Science & Theology News, attacked Intelligent Design theory last December. Alvin Plantinga, a philosopher from Notre Dame (the university, not the cathedral), responds:
Giberson also complains that ID hasn’t generated further research or research projects. This may be true. At any rate the proponents of ID haven’t, as far as I know, actually come through with much by way of further research. Perhaps even the central claims of ID are by nature not fecund. They are not such as to suggest further lines of research, at least of the sort [the physicist] George Gamow came up with. Perhaps that’s true. Still, their conclusions might very well be “scientific.” They might very well be true, and they might very well be of great importance, very much worth knowing.
Exchange filched from Prosblogion.
2/21/06
What I bought at the candy store
[Many links to pages in Hebrew, which is probably not good linking etiquette.]
1. Yehuda Feliks, Animals and Plants of the Torah. Because I've always wanted to own it.
2. Moshe Tzvi Segal, The Complete Ben-Sira. Because of a certain discussion we've been having over here, Dov W. and I.
3. Jacob Katz, Between Jews and Gentiles. Because I've been reading Jacob Katz ever since I became interested in Jewish history. And because the book cost five dollars.
4. Yitzkhak Klein, Religion as a Philosophical Problem. I have no idea if the book's any good or not, but a cursory browse caught my interest. And this too cost me only five dollars.
5. Sha'agas Aryeh, the responsa.
What I didn't buy, but wanted to
A history of medieval Hebrew linguistics.
A visual Hebrew dictionary.
Mysterious Creatures.
A Dictionary of Babylonian Aramaic. (Someday it'll drop below $100.)
What was supposedly in stock at the sale, but couldn't be found by the salesperson
The Festivals and Jewish Law, by Zevin.
What I already own, and plan to write about soon-ish on this blog
Medicine and Jewish Law, volume III.
What I noticed at this year's sale
Less people, less kitsch Judaica, fewer books. Or maybe that was just my imagination.
[Many links to pages in Hebrew, which is probably not good linking etiquette.]
1. Yehuda Feliks, Animals and Plants of the Torah. Because I've always wanted to own it.
2. Moshe Tzvi Segal, The Complete Ben-Sira. Because of a certain discussion we've been having over here, Dov W. and I.
3. Jacob Katz, Between Jews and Gentiles. Because I've been reading Jacob Katz ever since I became interested in Jewish history. And because the book cost five dollars.
4. Yitzkhak Klein, Religion as a Philosophical Problem. I have no idea if the book's any good or not, but a cursory browse caught my interest. And this too cost me only five dollars.
5. Sha'agas Aryeh, the responsa.
What I didn't buy, but wanted to
A history of medieval Hebrew linguistics.
A visual Hebrew dictionary.
Mysterious Creatures.
A Dictionary of Babylonian Aramaic. (Someday it'll drop below $100.)
What was supposedly in stock at the sale, but couldn't be found by the salesperson
The Festivals and Jewish Law, by Zevin.
What I already own, and plan to write about soon-ish on this blog
Medicine and Jewish Law, volume III.
What I noticed at this year's sale
Less people, less kitsch Judaica, fewer books. Or maybe that was just my imagination.
2/19/06
Bravo, Sherwin Nuland!
The doctor tells it like it is in this past week's Forward with a necessary editorial about metzitzah b'peh.
The doctor tells it like it is in this past week's Forward with a necessary editorial about metzitzah b'peh.
2/17/06
Field trip!
On Sunday, to the YU Seforim Sale. Not just a great place to buy seforim, but a once-yearly opportunity for amateur sociology among the (modern) Orthodox. Uninformed observations coming your way next week.
It would be nice to meet Gil, Menachem, S., Mississippi Fred MacDowell, anyone else from Maven Yavin, Steg - pretty much any blogger, J- or not.
PS: And prolific commentator Dov W., of course.
On Sunday, to the YU Seforim Sale. Not just a great place to buy seforim, but a once-yearly opportunity for amateur sociology among the (modern) Orthodox. Uninformed observations coming your way next week.
It would be nice to meet Gil, Menachem, S., Mississippi Fred MacDowell, anyone else from Maven Yavin, Steg - pretty much any blogger, J- or not.
PS: And prolific commentator Dov W., of course.
2/15/06
A real epidemiology blog
Perhaps they'll cover the recent, mildly surprising finding from the Women's Health Initiative: calcium and vitamin D supplementation does not reduce the risk of hip fracture in healthy, post-menopausal women. Or maybe I'll talk about that later.
Perhaps they'll cover the recent, mildly surprising finding from the Women's Health Initiative: calcium and vitamin D supplementation does not reduce the risk of hip fracture in healthy, post-menopausal women. Or maybe I'll talk about that later.
Je ne parle pas la radiologie
Without language, the doctor can't diagnose. But what happens when the doctor has to switch languages?
John Bruzzi, an Irish radiologist, recently spent time on a fellowship in France. In a surprisingly well-written essay for the New England Journal of Medicine, he describes what it was like to translate his painstakingly honed diagnostician's vocabulary into his not-quite-perfect French.
Without language, the doctor can't diagnose. But what happens when the doctor has to switch languages?
John Bruzzi, an Irish radiologist, recently spent time on a fellowship in France. In a surprisingly well-written essay for the New England Journal of Medicine, he describes what it was like to translate his painstakingly honed diagnostician's vocabulary into his not-quite-perfect French.
When I arrived, I was proficient enough in French to formulate a radiology report, though it involved a long, painful process of interpreting the images and mentally translating my thoughts into French. My reports were short and full of curt, declarative sentences that read like barked military orders. ("The right lung is normal. In the left upper lobe there is a mass. A big mass. 5x6 cm. Probably lung cancer.") Subordinate clauses, subjunctives, and commas went out the window. When asked my opinion about something, I could only point to the relevant images and describe abnormalities as "cancer" or "infection," "big" or "small." There were no gray areas, no doubts, no conjectures. Sitting on the fence — a radiologist's stock in trade — necessitates using words for balance, weighing diagnostic probabilities, and leaning toward the heavier side. But because I couldn't use the subjunctive mood, I was forced into the realm of apparent diagnostic certainty.
The Journal requires subscription for full-text access. Far be it from me to steal a dollar from the Cambridge biomedical establishment -- I'm not going to post the whole article here. Ask someone to get it for you, since it's well worth reading.
2/14/06
Presenting future poetic greatness!
סק דרגא בחר שושבינא
Go up a level to choose a friend. (Tractate Yevamos, 63a)
The above is all the more relevant when one chooses a friend who's a poet. I'm lucky to have someone I can train my sights on as he scrambles nimbly up the brambled slopes towards an unimagined art.
In other words, catch him now before you have to pay admission. I present Andrew Sage, and an ideal opportunity to listen to him read (together with Jan Heller Levi and Sally-Ann Hard):
סק דרגא בחר שושבינא
Go up a level to choose a friend. (Tractate Yevamos, 63a)
The above is all the more relevant when one chooses a friend who's a poet. I'm lucky to have someone I can train my sights on as he scrambles nimbly up the brambled slopes towards an unimagined art.
In other words, catch him now before you have to pay admission. I present Andrew Sage, and an ideal opportunity to listen to him read (together with Jan Heller Levi and Sally-Ann Hard):
Saturday, Feb 25, 3pm, at the Ear Inn (326 Spring Street, west of Greenwich St).
2/12/06
Did I mention I'm going to China?
Well, I am. I hope you're not the last to know.
In any case, there are many preparations to make, desperate requests to issue, Chinese characters to learn, Pesach supplies to jerry-rig, etc., etc.
What comes to mind now is that I have to leave my books behind, or at least most of them.
For now, one simple question: if you could only bring five books on a trip abroad, what would they be? Feel free to tailor the question to you. (If you're an observant Jew, please answer this question: which five seforim would you take on a trip abroad?)
Please leave answers in the comments, or train a eagle to fly over the frozen avenues of Manhattan and tap its beak on my window in code.
Well, I am. I hope you're not the last to know.
In any case, there are many preparations to make, desperate requests to issue, Chinese characters to learn, Pesach supplies to jerry-rig, etc., etc.
What comes to mind now is that I have to leave my books behind, or at least most of them.
For now, one simple question: if you could only bring five books on a trip abroad, what would they be? Feel free to tailor the question to you. (If you're an observant Jew, please answer this question: which five seforim would you take on a trip abroad?)
Please leave answers in the comments, or train a eagle to fly over the frozen avenues of Manhattan and tap its beak on my window in code.
2/11/06
Translation
wool his snow
frost his ash
ice his scattered
crumbs. his cold!
melts by his word.
his wind, water flows.
Original here.
wool his snow
frost his ash
ice his scattered
crumbs. his cold!
melts by his word.
his wind, water flows.
Original here.
2/8/06
Be nice to your doctor!
You never know when you might need him.
The following is my favorite midrash for this week's Torah portion. It should soon become obvious why that is:
Midrash Rabbah, portion Beshalach, 21
Another matter regarding "Why do you cry out to Me? [Exodus 14:15]": It is written (Job 36:19): "Will Your riches avail, that are without stint (or all the forces of Your strength?)" What does this mean? According to R. Elazar ben Pdas: The parable says, "Honor your healer until you need him." Similarly, R. Shimon ben Lakish says, "Prepare a cry before your Creator so that you won't have enemies Above."
In this week's portion, Moses cries out to God -- a thing which puzzles the commentators, since God had already told Moses explicitly that Egypt would fail and the Israelites would be saved. In any case, one simple meaning of God's question, "Why do you cry out to Me?", is that Moses should not be crying out to God: it is the time for action. "Speak to the Israelites and [tell them that] they should go." Quit praying!
The midrash connects the verse in Exodus to an even more obscure verse in the Book of Job. Some take the word שוע in this verse to mean "riches," and render the word צר as "narrowness." Hence the translation above: "Will Your riches avail, that are without stint?"
The Rabbis quoted in this midrash, however, take שוע to mean "cry, petition" (in the sense of prayer), and צר to mean "foe." They might translate the verse this way: "Will you put your prayer in order before the foe has even appeared?" To this way of thinking, God's question to Moses is not "Why are you praying when there's action to be taken," but "Why are you praying before there's even anything to be worried about," i.e. before the Egyptians are even threatening to overtake the Israelites?
In other words, the general thrust of this midrash is that one should pray to God before one's enemies appear -- before one is in trouble. (The parallel versions of this midrash, in the Jerusalem Talmud and in the Midrash Tanchuma, support this understanding. In the Yerushalmi, the verse from Job is brought as an explanation for the parable, which there appears in Aramaic.) But the support brought in the midrash for this way of thinking -- the proverb brought by R. Elazar ben Pdas -- is what makes it fascinating.
"Honor your healer until you need him": what does this mean? First off, we should say that the Hebrew word רופא (royfe), though familiar in Modern Hebrew as the equivalent to English "doctor," means something else again in Rabbinic texts. (A lengthy review of the etymology and various meanings of the word is here.) A רופא is what could be called in other contexts a "soul healer," an expert who has the power to keep others healthy through Divine intercession.
To see this, compare Exodus 15:26, where God says (JPS translation): "'If thou wilt diligently hearken to the voice of the LORD thy God, and wilt do that which is right in His eyes, and wilt give ear to His commandments, and keep all His statutes, I will put none of the diseases upon thee, which I have put upon the Egyptians; for I am the LORD that healeth thee.'" That is, אני ד´ רופאך, I, God, am your רופא, your healer. But what sort of a healer cures diseases that have not been "put upon thee"? One which keeps the diseases from emerging in the first place. God the public-health worker? That would be an anachronism, unfortunately. God the faith healer makes more sense.
One more thing we need to understand: what does it mean to say "Honor your healer until you need him"? Jastrow lists a second meaning of the verb כבד, "to offer a gift." The healer is to be supported (financially!) by his community until such time as he's needed. Thus the prayer the Rabbis suggest in this midrash is in the nature of an investment. Prayer is "laid up" by the petitioner against a rainy day, or, rather, against the day when enemies come. (Maybe this provides the link between the verse in Job and the cited parable: the root ערך can also have the meaning "valuation.")
In other words, make sure to support your local healer. You never know when they might come in handy.
You never know when you might need him.
The following is my favorite midrash for this week's Torah portion. It should soon become obvious why that is:
מדרש רבה בשלח פרשה כא
דבר אחר מה תצעק אלי הדא הוא דכתיב (איוב לו, יט) היערוך שועך לא בצר מהו כן אמר רבי אלעזר בן פדת המשל אומר כבד את רופאך עד שלא תצטרך לו ורבי שמעון בן לקיש אומר ערך שוע כלפי בוראך כדי שלא יהיו לך צרים מלמעלן
Midrash Rabbah, portion Beshalach, 21
Another matter regarding "Why do you cry out to Me? [Exodus 14:15]": It is written (Job 36:19): "Will Your riches avail, that are without stint (or all the forces of Your strength?)" What does this mean? According to R. Elazar ben Pdas: The parable says, "Honor your healer until you need him." Similarly, R. Shimon ben Lakish says, "Prepare a cry before your Creator so that you won't have enemies Above."
In this week's portion, Moses cries out to God -- a thing which puzzles the commentators, since God had already told Moses explicitly that Egypt would fail and the Israelites would be saved. In any case, one simple meaning of God's question, "Why do you cry out to Me?", is that Moses should not be crying out to God: it is the time for action. "Speak to the Israelites and [tell them that] they should go." Quit praying!
The midrash connects the verse in Exodus to an even more obscure verse in the Book of Job. Some take the word שוע in this verse to mean "riches," and render the word צר as "narrowness." Hence the translation above: "Will Your riches avail, that are without stint?"
The Rabbis quoted in this midrash, however, take שוע to mean "cry, petition" (in the sense of prayer), and צר to mean "foe." They might translate the verse this way: "Will you put your prayer in order before the foe has even appeared?" To this way of thinking, God's question to Moses is not "Why are you praying when there's action to be taken," but "Why are you praying before there's even anything to be worried about," i.e. before the Egyptians are even threatening to overtake the Israelites?
In other words, the general thrust of this midrash is that one should pray to God before one's enemies appear -- before one is in trouble. (The parallel versions of this midrash, in the Jerusalem Talmud and in the Midrash Tanchuma, support this understanding. In the Yerushalmi, the verse from Job is brought as an explanation for the parable, which there appears in Aramaic.) But the support brought in the midrash for this way of thinking -- the proverb brought by R. Elazar ben Pdas -- is what makes it fascinating.
"Honor your healer until you need him": what does this mean? First off, we should say that the Hebrew word רופא (royfe), though familiar in Modern Hebrew as the equivalent to English "doctor," means something else again in Rabbinic texts. (A lengthy review of the etymology and various meanings of the word is here.) A רופא is what could be called in other contexts a "soul healer," an expert who has the power to keep others healthy through Divine intercession.
To see this, compare Exodus 15:26, where God says (JPS translation): "'If thou wilt diligently hearken to the voice of the LORD thy God, and wilt do that which is right in His eyes, and wilt give ear to His commandments, and keep all His statutes, I will put none of the diseases upon thee, which I have put upon the Egyptians; for I am the LORD that healeth thee.'" That is, אני ד´ רופאך, I, God, am your רופא, your healer. But what sort of a healer cures diseases that have not been "put upon thee"? One which keeps the diseases from emerging in the first place. God the public-health worker? That would be an anachronism, unfortunately. God the faith healer makes more sense.
One more thing we need to understand: what does it mean to say "Honor your healer until you need him"? Jastrow lists a second meaning of the verb כבד, "to offer a gift." The healer is to be supported (financially!) by his community until such time as he's needed. Thus the prayer the Rabbis suggest in this midrash is in the nature of an investment. Prayer is "laid up" by the petitioner against a rainy day, or, rather, against the day when enemies come. (Maybe this provides the link between the verse in Job and the cited parable: the root ערך can also have the meaning "valuation.")
In other words, make sure to support your local healer. You never know when they might come in handy.
An unmistakable Divine message
Town and Village Synagogue: 334 East 14th Street.
Curly's Vegetarian Diner: Now at 328 East 14th Street.
The message:
Pray. Eat veggie nachos.
Town and Village Synagogue: 334 East 14th Street.
Curly's Vegetarian Diner: Now at 328 East 14th Street.
The message:
Pray. Eat veggie nachos.
2/7/06
Why do African- and Hawaiian-Americans have a higher risk of lung cancer?
This article is illuminated by an accompanying background article in the Journal. See here, if you have NEJM access.
Ethnic and Racial Differences in the Smoking-Related Risk of Lung Cancer
Christopher A. Haiman, Sc.D., Daniel O. Stram, Ph.D., Lynne R. Wilkens, Dr.P.H., Malcolm C. Pike, Ph.D., Laurence N. Kolonel, M.D., Ph.D., Brian E. Henderson, M.D., and Loïc Le Marchand, M.D., Ph.D.
ABSTRACT
Background There is remarkable variation in the incidence of lung cancer among ethnic and racial groups in the United States.
Methods We investigated differences in the risk of lung cancer associated with cigarette smoking among 183,813 African-American, Japanese-American, Latino, Native Hawaiian, and white men and women in the Multiethnic Cohort Study. Our analysis included 1979 cases of incident lung cancer identified prospectively over an eight-year period, between baseline (1993 through 1996) and 2001.
Results The risk of lung cancer among ethnic and racial groups was modified by the number of cigarettes smoked per day. Among participants who smoked no more than 30 cigarettes per day, African Americans and Native Hawaiians had significantly greater risks of lung cancer than did the other groups. Among those who smoked no more than 10 and those who smoked 11 to 20 cigarettes per day, relative risks ranged from 0.21 to 0.39 (P<0.001) among Japanese Americans and Latinos and from 0.45 to 0.57 (P<0.001) among whites, as compared with African Americans. However, at levels exceeding 30 cigarettes per day, these differences were not significant. Differences in risk associated with smoking were observed among both men and women and for all histologic types of lung cancer.
Conclusions Among cigarette smokers, African Americans and Native Hawaiians are more susceptible to lung cancer than whites, Japanese Americans, and Latinos.
This article is illuminated by an accompanying background article in the Journal. See here, if you have NEJM access.
Ethnic and Racial Differences in the Smoking-Related Risk of Lung Cancer
Christopher A. Haiman, Sc.D., Daniel O. Stram, Ph.D., Lynne R. Wilkens, Dr.P.H., Malcolm C. Pike, Ph.D., Laurence N. Kolonel, M.D., Ph.D., Brian E. Henderson, M.D., and Loïc Le Marchand, M.D., Ph.D.
ABSTRACT
Background There is remarkable variation in the incidence of lung cancer among ethnic and racial groups in the United States.
Methods We investigated differences in the risk of lung cancer associated with cigarette smoking among 183,813 African-American, Japanese-American, Latino, Native Hawaiian, and white men and women in the Multiethnic Cohort Study. Our analysis included 1979 cases of incident lung cancer identified prospectively over an eight-year period, between baseline (1993 through 1996) and 2001.
Results The risk of lung cancer among ethnic and racial groups was modified by the number of cigarettes smoked per day. Among participants who smoked no more than 30 cigarettes per day, African Americans and Native Hawaiians had significantly greater risks of lung cancer than did the other groups. Among those who smoked no more than 10 and those who smoked 11 to 20 cigarettes per day, relative risks ranged from 0.21 to 0.39 (P<0.001) among Japanese Americans and Latinos and from 0.45 to 0.57 (P<0.001) among whites, as compared with African Americans. However, at levels exceeding 30 cigarettes per day, these differences were not significant. Differences in risk associated with smoking were observed among both men and women and for all histologic types of lung cancer.
Conclusions Among cigarette smokers, African Americans and Native Hawaiians are more susceptible to lung cancer than whites, Japanese Americans, and Latinos.
The Cherry Tree
1.
How many weeks of rest
with the sour cherries
before the summer sparks
what it can't have – sudden red
rising from the steaming ground
You can’t shut your eyes. They’re fixed
(though foreboding) on the ground forever
subsuming, reforming, engrossed in its layers
like a queen at her trousseau
again and again smoothing and folding knowing
thousand-root years bring growth and decay
to no conclusion but repetition.
Yet you stay to admire how this particular
season justifies itself before the magistrate
of the eye: distinct branches, self-defining trees
2.
Back now on peopled street: the mass is
miniature – diorama nestled in vastness.
This city is all facets’ fastness.
Back to kitchens and quick-wristed cooks which
train palates, tongues on new-thought dishes.
Back to those on battle pay, and
those who sent them, temples graying.
These wholes will lose their parts, but live as
cherry tree will have much to give us.
3.
The whole world an abstraction. This piece world
horizon not embracing but demanding
a sand-grained wind to tear the flag unfurled,
not suffering domestic understanding.
Domestic merely: home is not a womb
nor spouse a bosom friend. The unmet names
that know the truth of home are just in bloom
among those fields where runaway you came
to taste the flowers of what cannot be grown
except against the wall. Right there you found
what gardeners of every age have known:
since world is round its every part is round.
Each piece of fruit that stains the fingers orange
is only trap for seeds of future orange.
1.
How many weeks of rest
with the sour cherries
before the summer sparks
what it can't have – sudden red
rising from the steaming ground
You can’t shut your eyes. They’re fixed
(though foreboding) on the ground forever
subsuming, reforming, engrossed in its layers
like a queen at her trousseau
again and again smoothing and folding knowing
thousand-root years bring growth and decay
to no conclusion but repetition.
Yet you stay to admire how this particular
season justifies itself before the magistrate
of the eye: distinct branches, self-defining trees
2.
Back now on peopled street: the mass is
miniature – diorama nestled in vastness.
This city is all facets’ fastness.
Back to kitchens and quick-wristed cooks which
train palates, tongues on new-thought dishes.
Back to those on battle pay, and
those who sent them, temples graying.
These wholes will lose their parts, but live as
cherry tree will have much to give us.
3.
The whole world an abstraction. This piece world
horizon not embracing but demanding
a sand-grained wind to tear the flag unfurled,
not suffering domestic understanding.
Domestic merely: home is not a womb
nor spouse a bosom friend. The unmet names
that know the truth of home are just in bloom
among those fields where runaway you came
to taste the flowers of what cannot be grown
except against the wall. Right there you found
what gardeners of every age have known:
since world is round its every part is round.
Each piece of fruit that stains the fingers orange
is only trap for seeds of future orange.
2/2/06
How to talk to people
Sick people, I mean.
MEDICINE MENSCH: So...? How Are Things?
By Zackary Sholem Berger
February 3, 2006
Do you like to talk to other people? Sometimes I do; it depends how many there are. If I'm at a party, I slink toward the chips and-salsa or talk only to my wife. (Wallflowers don't blossom; they just climb farther up the wall.) If I'm talking to a friend of mine, it can take me some time to shut up. But if I'm face to face with a person who's providing a paid service — a checkup, a haircut, a repair — I have to remind myself to use the pleasantries that keep ordinary conversation going. I clam up.
Now that I'm almost a doctor, and, more to the point, now that I'm starting a rotation called Ambulatory Care (outpatient medicine, where patients are seen in clinic), I'll get to see the entire range of patient-conversationalists. But I have to figure out how to talk just enough.
This is both easier and harder than it sounds. Easier because the person you're talking to gives signals; following those signals is a well-marked route to conversing in a non-annoying fashion. (If the patient is checking her watch, rolling her eyes, or — as in the movie "Airplane" — tying a noose round her own neck, it's a good sign that her patience is wearing thin.) Talking less is generally good advice in any situation. No one likes a bore, least of all a bore whose favorite topic is your illnesses. Even though patients would like to be fully informed, most of them would like their information in a few concise paragraphs, not in a long-winded discourse.
On the other hand, a doctor needs to talk to get his work done. A silent doctor, like a silent lawyer, invites suspicion. But so does talking: Like lawyer and client, doctor and patient never can have a normal conversation; each of them is waiting for the other word to drop. The patient dreads the openings "There's something you need to know" or "We need to take a look at that" in the same way that the doctor never can escape the "doorknob questions" that the patient remembers just when she's about to leave: "Oh, I've been meaning to ask you something"; "Just one more thing."
If the conversation starts off on the right foot, it won't be so fraught for the parties involved. The accepted pedagogy in medical school is that one must begin in an "open-ended" way, and only later "cone in" to more specific, useful questions. Translated from jargon, this means that ideally the physician would welcome the patient into the office, invite him to sit and then wait silently, like an oracle. If necessary, at the very most one can utter a single word: "Well?" or "So?" Thus encouraged, a patient will spill the whole story without undue interference from the doctor.
If this oracular opening actually were to be adopted in most doctors' offices, patients would get confused and think they wandered into the psychotherapy suite by mistake. I've tried it myself a couple of times, and it spooks the patient. Of course, there's a compromise available: You can start off without a torrent of detailed questions, but your intro can be friendly and personable.
I've tried to see which opener works best for me. There's "What brings you here today?" An old favorite, but I can never say it without thinking of the old, jokey answer: "A taxi, doctor." I could ask, "What seems to be the problem?" Fine, I suppose, but it's nothing I actually would say in the course of a normal conversation. "How are things?" I used that once, and the patient said "Fine, thanks" — and stopped talking right there. I had to restart the conversation from a standstill.
There's a difference between what's supposed to happen (according to the theory of the clinic visit) and what actually happens. According to theory, I open up in a general vein and then become more specific as the patient reveals her problems. But the truth is that our conversation only traces the surface of the problems affecting the patient. What people say to their doctors often doesn't point to the true nature of their ailment. An office visit that the doctor considers notably successful (a problem correctly diagnosed, inroads made into diabetes control or reduction of cardiovascular risk) can appear completely useless to the patient: Her annoying cough hasn't gone away, and her back still hurts.
This is the conundrum of outpatient medicine. Since the patients seen in hospitals (where young doctors get their start) are sicker on average than they were decades ago, the bulk of today's training is focused on keeping them alive, or, in rare instances, on curing them. But day-to-day clinic medicine (and the role of doctors throughout much of history) has been not to save lives but to improve them, to make the acute problem less acute and the chronic one easier to bear.
When residents talk, they often say that clinic patients are hard to deal with. Do they mean that hospitalized patients, with their long lists of potentially fatal medical problems, are easy to treat? Maybe it's that patients in clinic, with their multiple medium-sized problems, come with the same considerable challenges and small-scale opportunities that are present in any interaction. The aim is to make incremental improvements while keeping an eye out for those brief openings that allow a significant change for the good. For the average clinic visit of 10 minutes or so, that's plenty to talk about.
That's all we have time for today, I'm afraid. Same time next month?
Zackary Sholem Berger has another patient waiting, but he cares about you personally. Write to him at doctor@forward.com.
Sick people, I mean.
MEDICINE MENSCH: So...? How Are Things?
By Zackary Sholem Berger
February 3, 2006
Do you like to talk to other people? Sometimes I do; it depends how many there are. If I'm at a party, I slink toward the chips and-salsa or talk only to my wife. (Wallflowers don't blossom; they just climb farther up the wall.) If I'm talking to a friend of mine, it can take me some time to shut up. But if I'm face to face with a person who's providing a paid service — a checkup, a haircut, a repair — I have to remind myself to use the pleasantries that keep ordinary conversation going. I clam up.
Now that I'm almost a doctor, and, more to the point, now that I'm starting a rotation called Ambulatory Care (outpatient medicine, where patients are seen in clinic), I'll get to see the entire range of patient-conversationalists. But I have to figure out how to talk just enough.
This is both easier and harder than it sounds. Easier because the person you're talking to gives signals; following those signals is a well-marked route to conversing in a non-annoying fashion. (If the patient is checking her watch, rolling her eyes, or — as in the movie "Airplane" — tying a noose round her own neck, it's a good sign that her patience is wearing thin.) Talking less is generally good advice in any situation. No one likes a bore, least of all a bore whose favorite topic is your illnesses. Even though patients would like to be fully informed, most of them would like their information in a few concise paragraphs, not in a long-winded discourse.
On the other hand, a doctor needs to talk to get his work done. A silent doctor, like a silent lawyer, invites suspicion. But so does talking: Like lawyer and client, doctor and patient never can have a normal conversation; each of them is waiting for the other word to drop. The patient dreads the openings "There's something you need to know" or "We need to take a look at that" in the same way that the doctor never can escape the "doorknob questions" that the patient remembers just when she's about to leave: "Oh, I've been meaning to ask you something"; "Just one more thing."
If the conversation starts off on the right foot, it won't be so fraught for the parties involved. The accepted pedagogy in medical school is that one must begin in an "open-ended" way, and only later "cone in" to more specific, useful questions. Translated from jargon, this means that ideally the physician would welcome the patient into the office, invite him to sit and then wait silently, like an oracle. If necessary, at the very most one can utter a single word: "Well?" or "So?" Thus encouraged, a patient will spill the whole story without undue interference from the doctor.
If this oracular opening actually were to be adopted in most doctors' offices, patients would get confused and think they wandered into the psychotherapy suite by mistake. I've tried it myself a couple of times, and it spooks the patient. Of course, there's a compromise available: You can start off without a torrent of detailed questions, but your intro can be friendly and personable.
I've tried to see which opener works best for me. There's "What brings you here today?" An old favorite, but I can never say it without thinking of the old, jokey answer: "A taxi, doctor." I could ask, "What seems to be the problem?" Fine, I suppose, but it's nothing I actually would say in the course of a normal conversation. "How are things?" I used that once, and the patient said "Fine, thanks" — and stopped talking right there. I had to restart the conversation from a standstill.
There's a difference between what's supposed to happen (according to the theory of the clinic visit) and what actually happens. According to theory, I open up in a general vein and then become more specific as the patient reveals her problems. But the truth is that our conversation only traces the surface of the problems affecting the patient. What people say to their doctors often doesn't point to the true nature of their ailment. An office visit that the doctor considers notably successful (a problem correctly diagnosed, inroads made into diabetes control or reduction of cardiovascular risk) can appear completely useless to the patient: Her annoying cough hasn't gone away, and her back still hurts.
This is the conundrum of outpatient medicine. Since the patients seen in hospitals (where young doctors get their start) are sicker on average than they were decades ago, the bulk of today's training is focused on keeping them alive, or, in rare instances, on curing them. But day-to-day clinic medicine (and the role of doctors throughout much of history) has been not to save lives but to improve them, to make the acute problem less acute and the chronic one easier to bear.
When residents talk, they often say that clinic patients are hard to deal with. Do they mean that hospitalized patients, with their long lists of potentially fatal medical problems, are easy to treat? Maybe it's that patients in clinic, with their multiple medium-sized problems, come with the same considerable challenges and small-scale opportunities that are present in any interaction. The aim is to make incremental improvements while keeping an eye out for those brief openings that allow a significant change for the good. For the average clinic visit of 10 minutes or so, that's plenty to talk about.
That's all we have time for today, I'm afraid. Same time next month?
Zackary Sholem Berger has another patient waiting, but he cares about you personally. Write to him at doctor@forward.com.
2/1/06
Take your bundle of [spice]...
I forgot, or more likely never knew, the meaning of אזוב (Exodus 12:22, שמות פרשת בא, ולקחתם אגדת אזוב). Onkelos translates it unhelpfully as איזובא. Saadiah Gaon says it means זעתר (za'athar), which Ibn Ezra translates as אוריגנו (origano/oreygano). (Ibn Ezra says of Saadiah's gloss that it "isn't likely" [זה לא יתכן] for Biblical and botanical reasons, but admits that he doesn't know what plant the word refers to.) Yidish-taytsh, I think, calls it אזובֿ, as does Yehoash.
The Septuagint renders the word as hyssopos 'hyssop.' Here's where I quote William H.C. Propp in Anchor Bible Exodus 1-18, where he chooses to call it "marjoram":
What relationship Saadiah's term za'athar has to modern-day zaatar, and why marjoram is called Origanum (so what's oregano, then?), are puzzles for wiser minds to solve.
Oh, here's a useful note:
I forgot, or more likely never knew, the meaning of אזוב (Exodus 12:22, שמות פרשת בא, ולקחתם אגדת אזוב). Onkelos translates it unhelpfully as איזובא. Saadiah Gaon says it means זעתר (za'athar), which Ibn Ezra translates as אוריגנו (origano/oreygano). (Ibn Ezra says of Saadiah's gloss that it "isn't likely" [זה לא יתכן] for Biblical and botanical reasons, but admits that he doesn't know what plant the word refers to.) Yidish-taytsh, I think, calls it אזובֿ, as does Yehoash.
The Septuagint renders the word as hyssopos 'hyssop.' Here's where I quote William H.C. Propp in Anchor Bible Exodus 1-18, where he chooses to call it "marjoram":
The LXX rendering . . . is based on the phonetic similarity to Hebrew 'ezob, a common translation technique for LXX (Tov 1979). But even when Hebrew and Greek words are truly related via borrowing, their meanings may differ slightly. 'Ezob is "Syrian hyssop" (Origanum syriacum l.) or marjoram, still used by Samaritans for Pesakh (Saadiah; Crowfoot and Baldensperger 1931). Greek hyssopos is a different plant altogether (Zohary 1982:96). A literalist might object that we should seek a native Egyptian plant, rather than a Palestinian, but no doubt later Israelite practice has been transplanted into an Egyptian setting.
The marjoram tuft, readily available (cf. 1 Kgs 5:13), is essentially a brush (Cassuto 1967:143 [this is also implied in the commentaries of Ibn Ezra and Saadiah -- ZB]). Segal (1963:159) and Jacob (1992:328) plausibly infer that it insulates lay officiants from the dangers of the holy; true priests, in contrast, manipulate blood with their fingers. Marjoram is also used to apply blood in ritual purifications (Ps 51:9), particularly from skin disease (Leviticus 14 passim) and death (Num 19:18, cf v 6). According to Heb 9:19, it was also used for the Covenant ceremony of Exod 24:8.
What relationship Saadiah's term za'athar has to modern-day zaatar, and why marjoram is called Origanum (so what's oregano, then?), are puzzles for wiser minds to solve.
Oh, here's a useful note:
In the countries of the Eastern Mediterranean, there is often no clear distinction made between a couple of aromatic herbs of the mint family: Names like Turkish kekik or Arabic zatar/satar [زعتر, صعتر] and related forms in Hebrew and Persian, often in conjunction with qualifying or descriptive adjectives, may be applied to a varity of native herbs including, but not restricted to, oregano, marjoram, thyme and savory. Usage may vary even within a given language, depending on the region and particularly on the local flora. In Jordan, zahtar usually means a spice mixture containing such herbs (see sumac for more).
1/30/06
The argument from flawed design
[Corrected from an earlier version based on comments. Thanks to my bar-plugta.]
The argument from design begins with the observation that the universe is so intricately complex that only a builder could have created it. The only such builder is the Builder.
An offshoot of this argument is the Intelligent Design theory, which Hirhurim pointed out should better be called a religious philosophy. According to this so-called alternative to evolution, the details of biological systems require a Designer to assemble them all just so.
The problem with both the Intelligent Design philosophy and the argument from design is that complexity need not be explained by a Designer. But the problem of imperfections in the world's design is also relevant. Part of the idea of "complexity" inherent in the Design Argument (and the famous watch metaphor) is that the world's intricacy is necessary to its functioning, in the same way that a complicated mechanism underlies the way a watch works.
An "intelligent design" biologist (to the extent that one exists) would not credit evolution for regulatory proteins and their interlocking complexity. Rather, he would say that this is an instance of special creation, since nothing so complicated as protein-kinase molecular biology could have arisen by chance, even over millions of years.
But the complexity of biological systems is riddled with irregularities and imperfections that weaken the watchmaker metaphor and make us ask the question: what sort of designer would include them? Regulatory proteins can be hijacked by viruses or can malfunction through environmental insult. Even to some nephrologists I know, the kidneys seem like jerry-rigged, hopelessly complicated organs. And if the fine-tuned electrical conduction of the heart goes haywire, you can forget about the ventricles acting as pacemakers on their own. They're likely to conk out altogether, which is deadly to the organism.
Why would God build such imperfections into the system? The test for justifications of God's moral actions, as I think Paul van Inwagen touches upon in one of his lectures, is their narrative plausibility. (The well-known and ancient argument "I believe because it is impossible" can't help us in distinguishing between competing plausible accounts of God's actions.) If we compare the theory of evolution to the theory of special creation of biological systems, the second option presents us with questions that are very difficult to answer: if God specially created molecular biology, why couldn't He (or She) have done a better job? Why doesn't our heart work better? Why are we bipedal when it causes such pain over increased lifespans?
On the other hand, believing in both God and evolution provides a satisfying narrative. God created a system which is higher-order than even humans themselves, a mechanism which governs life in its complexity. This does not gainsay our moral responsibility or particularist relationships with God. Evolution and the Torah are not mutually exclusive. Rather, evolution (so to speak) is a construction more appropriate for the perfect Builder than imperfect special creation.
In other words, the argument from design assumes that complexity requires a Designer. Since not every kind of complexity needs a designer, though, we need to limit the argument to those sorts of complexity which fit the bill. I think that the irregularities and inconsistencies of biological systems -- those which intelligent design advocates hold to be prime examples of special creation -- argue against such "Designing" with a capital D.
A question was raised in the comments: how can we assume that God would design a complexity comprehensible by humans? But that's the very nature of designed complexity! If we point to an irregularity-riddled complexity and say, "This requires a Designer," we are left with very puzzling, perhaps indefensible notions of how the Designer must act.
[Corrected from an earlier version based on comments. Thanks to my bar-plugta.]
The argument from design begins with the observation that the universe is so intricately complex that only a builder could have created it. The only such builder is the Builder.
An offshoot of this argument is the Intelligent Design theory, which Hirhurim pointed out should better be called a religious philosophy. According to this so-called alternative to evolution, the details of biological systems require a Designer to assemble them all just so.
The problem with both the Intelligent Design philosophy and the argument from design is that complexity need not be explained by a Designer. But the problem of imperfections in the world's design is also relevant. Part of the idea of "complexity" inherent in the Design Argument (and the famous watch metaphor) is that the world's intricacy is necessary to its functioning, in the same way that a complicated mechanism underlies the way a watch works.
An "intelligent design" biologist (to the extent that one exists) would not credit evolution for regulatory proteins and their interlocking complexity. Rather, he would say that this is an instance of special creation, since nothing so complicated as protein-kinase molecular biology could have arisen by chance, even over millions of years.
But the complexity of biological systems is riddled with irregularities and imperfections that weaken the watchmaker metaphor and make us ask the question: what sort of designer would include them? Regulatory proteins can be hijacked by viruses or can malfunction through environmental insult. Even to some nephrologists I know, the kidneys seem like jerry-rigged, hopelessly complicated organs. And if the fine-tuned electrical conduction of the heart goes haywire, you can forget about the ventricles acting as pacemakers on their own. They're likely to conk out altogether, which is deadly to the organism.
Why would God build such imperfections into the system? The test for justifications of God's moral actions, as I think Paul van Inwagen touches upon in one of his lectures, is their narrative plausibility. (The well-known and ancient argument "I believe because it is impossible" can't help us in distinguishing between competing plausible accounts of God's actions.) If we compare the theory of evolution to the theory of special creation of biological systems, the second option presents us with questions that are very difficult to answer: if God specially created molecular biology, why couldn't He (or She) have done a better job? Why doesn't our heart work better? Why are we bipedal when it causes such pain over increased lifespans?
On the other hand, believing in both God and evolution provides a satisfying narrative. God created a system which is higher-order than even humans themselves, a mechanism which governs life in its complexity. This does not gainsay our moral responsibility or particularist relationships with God. Evolution and the Torah are not mutually exclusive. Rather, evolution (so to speak) is a construction more appropriate for the perfect Builder than imperfect special creation.
In other words, the argument from design assumes that complexity requires a Designer. Since not every kind of complexity needs a designer, though, we need to limit the argument to those sorts of complexity which fit the bill. I think that the irregularities and inconsistencies of biological systems -- those which intelligent design advocates hold to be prime examples of special creation -- argue against such "Designing" with a capital D.
A question was raised in the comments: how can we assume that God would design a complexity comprehensible by humans? But that's the very nature of designed complexity! If we point to an irregularity-riddled complexity and say, "This requires a Designer," we are left with very puzzling, perhaps indefensible notions of how the Designer must act.
Turn it and turn it, for stuffing is in it
...דמליתא בה (?)
The plush Torah is pretty cute, but its smile is incongruous. Torah makes you happy, it could be argued, but I wouldn't call it sunny or friendly. If I were an Amalekite I would see the plush Torah in my nightmares. (Then again, if I were an Amalekite, I'd have plenty of other things to worry about.)
*If anyone can think of a good Aramaic translation for "stuffing," half of my kingdom is theirs.
...דמליתא בה (?)
The plush Torah is pretty cute, but its smile is incongruous. Torah makes you happy, it could be argued, but I wouldn't call it sunny or friendly. If I were an Amalekite I would see the plush Torah in my nightmares. (Then again, if I were an Amalekite, I'd have plenty of other things to worry about.)
*If anyone can think of a good Aramaic translation for "stuffing," half of my kingdom is theirs.
1/26/06
What hath frogs wrought
The word צפרדע (frog, or, collectively, "frogs") is found in two places in Psalms. The order of the plagues dealt the Egyptians differs in Psalms from the recounting in Exodus. One traditional explanation for this (as suggested by the Radak, R. David Kimchi) is that the true order is represented in Exodus, so there's nothing lost by a change in the order in Psalms (which according to this understanding presumably differs for rhetorical reasons). The historical-critical explanation, not surprisingly, is that different traditions, or source texts, underlie the various recountings of the Exodus tale.
This all means that variances in Psalms (when compared to Exodus) should be looked at closely. In this week's parasha, here's how Egypt is affected by the frogs:
The word צפרדע (frog, or, collectively, "frogs") is found in two places in Psalms. The order of the plagues dealt the Egyptians differs in Psalms from the recounting in Exodus. One traditional explanation for this (as suggested by the Radak, R. David Kimchi) is that the true order is represented in Exodus, so there's nothing lost by a change in the order in Psalms (which according to this understanding presumably differs for rhetorical reasons). The historical-critical explanation, not surprisingly, is that different traditions, or source texts, underlie the various recountings of the Exodus tale.
This all means that variances in Psalms (when compared to Exodus) should be looked at closely. In this week's parasha, here's how Egypt is affected by the frogs:
כז וְאִם-מָאֵן אַתָּה, לְשַׁלֵּחַ: הִנֵּה אָנֹכִי, נֹגֵף אֶת-כָּל-גְּבוּלְךָ--בַּצְפַרְדְּעִים.
Exodus 7:27 And if thou refuse to let them go, behold, I will smite all thy borders with frogs.
כח וְשָׁרַץ הַיְאֹר, צְפַרְדְּעִים, וְעָלוּ וּבָאוּ בְּבֵיתֶךָ, וּבַחֲדַר מִשְׁכָּבְךָ וְעַל-מִטָּתֶךָ; וּבְבֵית עֲבָדֶיךָ וּבְעַמֶּךָ, וּבְתַנּוּרֶיךָ וּבְמִשְׁאֲרוֹתֶיךָ.
28 And the river shall swarm with frogs, which shall go up and come into thy house, and into thy bed-chamber, and upon thy bed, and into the house of thy servants, and upon thy people, and into thine ovens, and into thy kneading-troughs.
כט וּבְכָה וּבְעַמְּךָ, וּבְכָל-עֲבָדֶיךָ--יַעֲלוּ, הַצְפַרְדְּעִים.
29 And the frogs shall come up both upon thee, and upon thy people, and upon all thy servants.'
ב וַיֵּט אַהֲרֹן אֶת-יָדוֹ, עַל מֵימֵי מִצְרָיִם; וַתַּעַל, הַצְּפַרְדֵּעַ, וַתְּכַס, אֶת-אֶרֶץ מִצְרָיִם.
Exodus 8:2 And Aaron stretched out his hand over the waters of Egypt; and the frogs came up, and covered the land of Egypt.
ג וַיַּעֲשׂוּ-כֵן הַחַרְטֻמִּים, בְּלָטֵיהֶם; וַיַּעֲלוּ אֶת-הַצְפַרְדְּעִים, עַל-אֶרֶץ מִצְרָיִם.
3 And the magicians did in like manner with their secret arts, and brought up frogs upon the land of Egypt.
ד וַיִּקְרָא פַרְעֹה לְמֹשֶׁה וּלְאַהֲרֹן, וַיֹּאמֶר הַעְתִּירוּ אֶל-יְהוָה, וְיָסֵר הַצְפַרְדְּעִים, מִמֶּנִּי וּמֵעַמִּי; וַאֲשַׁלְּחָה, אֶת-הָעָם, וְיִזְבְּחוּ, לַיהוָה.
4 Then Pharaoh called for Moses and Aaron, and said: 'Entreat the LORD, that He take away the frogs from me, and from my people; and I will let the people go, that they may sacrifice unto the LORD.'
Let's compare Psalm 78:
מה יְשַׁלַּח בָּהֶם עָרֹב, וַיֹּאכְלֵם; וּצְפַרְדֵּעַ, וַתַּשְׁחִיתֵם.
45 He sent among them swarms of flies, which devoured them; and frogs, which destroyed them.
"Them" refers here to the Egyptians, I think.
The question is: which destruction is meant? The emphasis in Exodus is on the frogs' unstoppable fecundity, not on their destructive power. Rashi, commenting on the word "destroyed them" (ותשחיתם) in the verse in Psalms, says שומטין את ביציהם, "they [the frogs] took away their [the Egyptians'?] eggs." The reference is unclear to me, and I bet he's referring to a midrash I can't find right now. Perhaps Rashi is making an association with the root ש.ח.ת "destruction," which is known to Jews in the phrase השחתת זרע "[wanton] destruction of seed."
Perhaps it is the case (using a historical-critical approach) that the Psalmist knew of a different tradition, in which the frogs were not fecund but destructive. Rashi is combining their two effects, if I understand him correctly: since they were so multiplicative, they stole or took away the eggs of other creatures. Unfortunately, I'm still not clear on what Rashi means and whose eggs he's referring to. Any help here?
Prosperity = death?
This week's epidemiology abstract.
While mortality has decreased over the past century, superimposed on that decline have been occasional spikes. This study endeavored to confirm this observation by correlating economic with mortality indices in a statistical way. I haven't read the article yet, but the abstract piques my interest.
Increasing mortality during the expansions of the US economy, 1900–1996
Author: Granados, José A Tapia
Source: International Journal of Epidemiology, Volume 34, Number 6, December 2005, pp. 1194-1202(9)
Background In Western countries mortality dropped throughout the 20th century, but over and above the long-term falling trend, the death rate has oscillated over time. It has been postulated that these short-term oscillations may be related to changes in the economy.
Methods To ascertain if these short-term oscillations are related to fluctuations in the economy, age-adjusted total mortality and mortality for specific population groups, ages and causes of death were transformed into rate of change or percentage deviation from trend, and were correlated and regressed on indicators of the US economy during the 20th century, transformed in the same way.
Results Statistically and demographically significant results show that the decline of total mortality and mortality for different groups, ages and causes accelerated during recessions and was reduced or even reversed during periods of economic expansion—with the exception of suicides which increase during recessions. In recent decades these effects are stronger for women and non-whites.
Conclusions Economic expansions are associated with increasing mortality. Suggested pathways to explain this deceleration or even reversal of the secular decline in mortality during economic expansions include both material and psychosocial effects of the economic upturns: expansion of traffic and industrial activity directly raising injury-related mortality, decreased immunity levels (owing to rising stress and reduction of sleep time, social interaction and social support), and increased consumption of tobacco, alcohol and saturated fats.
Keywords: Economic conditions; macroeconomic factors; economic recession; unemployment; mortality determinants; age-specific death rates; causes of death; demography
This week's epidemiology abstract.
While mortality has decreased over the past century, superimposed on that decline have been occasional spikes. This study endeavored to confirm this observation by correlating economic with mortality indices in a statistical way. I haven't read the article yet, but the abstract piques my interest.
Increasing mortality during the expansions of the US economy, 1900–1996
Author: Granados, José A Tapia
Source: International Journal of Epidemiology, Volume 34, Number 6, December 2005, pp. 1194-1202(9)
Background In Western countries mortality dropped throughout the 20th century, but over and above the long-term falling trend, the death rate has oscillated over time. It has been postulated that these short-term oscillations may be related to changes in the economy.
Methods To ascertain if these short-term oscillations are related to fluctuations in the economy, age-adjusted total mortality and mortality for specific population groups, ages and causes of death were transformed into rate of change or percentage deviation from trend, and were correlated and regressed on indicators of the US economy during the 20th century, transformed in the same way.
Results Statistically and demographically significant results show that the decline of total mortality and mortality for different groups, ages and causes accelerated during recessions and was reduced or even reversed during periods of economic expansion—with the exception of suicides which increase during recessions. In recent decades these effects are stronger for women and non-whites.
Conclusions Economic expansions are associated with increasing mortality. Suggested pathways to explain this deceleration or even reversal of the secular decline in mortality during economic expansions include both material and psychosocial effects of the economic upturns: expansion of traffic and industrial activity directly raising injury-related mortality, decreased immunity levels (owing to rising stress and reduction of sleep time, social interaction and social support), and increased consumption of tobacco, alcohol and saturated fats.
Keywords: Economic conditions; macroeconomic factors; economic recession; unemployment; mortality determinants; age-specific death rates; causes of death; demography
1/23/06
A Herculean feat
To (unngggh) somehow use the power of the Bible (unnggh) without (arrgh) being religious! Whew!
Amy Davidson of The New Yorker and Ari Shavit of Ha'aretz hit upon a thing called The Bible as Literature. Strange but true!
To (unngggh) somehow use the power of the Bible (unnggh) without (arrgh) being religious! Whew!
Amy Davidson of The New Yorker and Ari Shavit of Ha'aretz hit upon a thing called The Bible as Literature. Strange but true!
Sharon talked about his own attachment to the land in your interviews with him. You said earlier that the settlers saw him as too secular. It’s a strange thing—he speaks about the land in Biblical terms, evoking Biblical figures, without ever being religious.
Sharon was a godless person, in a very profound way. He had no religion, no faith. When you look at the brutal chapters of his biography, you can say that there was something of the brutal secularist about him; this was the modus operandi of a person who’s really not God-fearing in any way. This is fact No. 1. Fact No. 2 is that he had a very strong sense of history, with a special attachment to the land, and a very strong Biblical memory—the Bible and the land came together in a potent fusion process within him. He was truly a nationalist romantic, in an almost scary way. The two sides seem to be contradictory, but, if you look at the history of Zionism, you see that there is not that much of a contradiction. For the early Zionists, the Labor-movement Zionists, history replaced God, and the Bible replaced both the Talmud and the Orthodox way of living as a Jew. History was the God of the Zionists. The idea was to bring the Jews—who, in the old Zionist terminology, had lived outside of history—back to the family of nations, the theatre of nations, where there is peace and war. This was the great thrill of the founding fathers of Zionism. And, in the same way, the Bible, being taken and read as the book about Jews living in this land, with a real, physical life as a nation, cultivating the land, defending the land—this was very powerful for the young Zionists and the young Sabras of Sharon’s generation. He took it perhaps to a bit of an extreme, because he was a person of extremes, but this intimate relationship with the land and with Biblical legacy and tradition actually goes well together with the godless dimension of his personality, and, in many ways, makes him the last of this early line of Zionists; we are not going to see any more of this type in the future.
1/22/06
Entsiklopedia haYehudit
This appears to be a free, readily searchable compendium of information about (traditional religious) Judaism taken from already published sources. In Hebrew.
This appears to be a free, readily searchable compendium of information about (traditional religious) Judaism taken from already published sources. In Hebrew.
1/19/06
O-bashing, continued
Third in an ever-more intermittent series.
I don't think boys younger than bar-mitzvah age should ever wear suits. It makes them look like Little Lord Fauntleroy or pint-size members of the Mob. Yet this appears to be de rigueur in many of my neighborhood Charedi shuls. Is the Shtetl, as imagined by Orthodox ideologues, populated by suit-wearing nine-year-olds?
(A Shtetl, thus capitalized, is a magical, mythically pious place, which even in the modern age harbored no doubt, heresy, or heterodoxy. Some very important Orthodox rabbis, whose naivete in this matter is charming, have quoted works of Yiddish literature [literature! that's imaginative writing, folks, whose relationship to reality is -- at its closest -- beside the point!] as a faithful historical record of what life in the Shtetl must have been like. Cf. R. Soloveitchik in Halachic Man, part 2, with a long footnote quoting I.L. Peretz, and, I believe, R. Aharon Lichtenstein referencing Sholem Aleichem, though I can't find the Lichtenstein text right now.)
But these are aesthetic criticisms, and can easily be refuted. ("Why, I find suit-wearing nine-year-olds deliciously heartwarming!")
This installment address a broader fault of Orthodoxy, viz.: the inability to admit (or, better, face the fact) that great rabbis of the past were often wrong in many ways. I'll take two examples in summary form. (These are examples I've encountered recently in my own Torah study, which means they're more interesting for me to blog about than rehashed and well-known sources [e.g. misogynistic sayings from the Gemara]).
In the tractate Eruvin of the Babylonian Talmud, page 59a (ערובין נט. תוספות ד"ה ותחומין דרבנן, for those of you following along at home), the writers of the Tosefot talk about whether certain classes of people are believable as witnesses for certain classes of ritual law (eruvs, kosher slaughter, setting aside of the challah). Their argument concludes: "If searching for chametz were a Torah-level requirement, women would not be believable [as to their testimony that such a search had been properly completed], even if they're directly involved in the task, because searching for chametz requires punctiliousness and great care. Therefore [in this case] one should worry about women's laziness more than in another case. That too is the meaning of the Jerusalem Talmud, [where it is said that] women are not believable with regard to searching for chametz, because they are lazy and search only the most minimal amount."
Now, I can't say that I'm surprised at such a statement. Misogynistic statements in the Gemara are a dime-a-dozen (as are legal innovations for the benefit of women, albeit with lesser frequency). Nor is this Tosfos a vital pillar of Jewish thought or law (though women's "unfitness" as witnesses has been a long and, actually, quite sordid chapter of halachah). (It's a very interesting Tosfos, of course, as most of them are, but not for its misogyny. I think this Tosfos might hint that "bedikas khomets" is more akin to "Pesach cleaning" than a modern-day halachist would admit.) The reason I bring it up here is that I can guess exactly how an average Orthodox rabbi would respond to it: with apologetics. Perhaps "Oh, we don't pasken like Tosfos here" (I don't know if we do or not), or "This is a metaphysical truth about women's innate capacities" or even "Who are we to criticize Tosfos"?
Here's the most cogent and satisfying way to read the statement of Tosfos with regard to women's laziness: It's wrong. Case closed. This doesn't mean that I'm arrogant, or reject the authority of Torah, or think I know more than the Baalei Tosfos. It doesn't even mean that I eat pork chops with a side of cheescake on Yom Kippur. It just means that sometimes rabbis are wrong. We gay-loving, jeans-wearing, Debbie Friedman-singing Conservative Jews certainly have our faults (hint: only one of those three activities is a sin in my book, and it's not being gay), but we can respect rabbis while calling them on their mistakes and not get tied up in knots about it.
There's a second example I'll give. It's shorter. According to halachah (the Rambam, at any rate, and I believe the Shulchan Aruch and the Remo as well; consult your local rabbi if you're brave enough to talk to her about it!), you're not allowed to have sex during the daytime or by the light of a candle. Why's that? A longish discussion in tractate Niddah of the Babylonian Talmud, starting on 16b, comes down to this: there's an angel (or demon, pick your translation) who deals with conception, and she's only active at night. Now this Gemara is not wrong, exactly. It's a convincing and consistent implication of a magical state of affairs. Unfortunately, I don't believe in the Gemara's magic. What do I do about it? Again, I could wax apologetic (it's a metaphorical apperception of a metaphysical truth! it's a guard against overpromiscuousness in the married couple! it's a segule for exciting lovemaking!), or I could say: I understand (or at least I think I do), and I don't agree. Case closed.
Third in an ever-more intermittent series.
I don't think boys younger than bar-mitzvah age should ever wear suits. It makes them look like Little Lord Fauntleroy or pint-size members of the Mob. Yet this appears to be de rigueur in many of my neighborhood Charedi shuls. Is the Shtetl, as imagined by Orthodox ideologues, populated by suit-wearing nine-year-olds?
(A Shtetl, thus capitalized, is a magical, mythically pious place, which even in the modern age harbored no doubt, heresy, or heterodoxy. Some very important Orthodox rabbis, whose naivete in this matter is charming, have quoted works of Yiddish literature [literature! that's imaginative writing, folks, whose relationship to reality is -- at its closest -- beside the point!] as a faithful historical record of what life in the Shtetl must have been like. Cf. R. Soloveitchik in Halachic Man, part 2, with a long footnote quoting I.L. Peretz, and, I believe, R. Aharon Lichtenstein referencing Sholem Aleichem, though I can't find the Lichtenstein text right now.)
But these are aesthetic criticisms, and can easily be refuted. ("Why, I find suit-wearing nine-year-olds deliciously heartwarming!")
This installment address a broader fault of Orthodoxy, viz.: the inability to admit (or, better, face the fact) that great rabbis of the past were often wrong in many ways. I'll take two examples in summary form. (These are examples I've encountered recently in my own Torah study, which means they're more interesting for me to blog about than rehashed and well-known sources [e.g. misogynistic sayings from the Gemara]).
In the tractate Eruvin of the Babylonian Talmud, page 59a (ערובין נט. תוספות ד"ה ותחומין דרבנן, for those of you following along at home), the writers of the Tosefot talk about whether certain classes of people are believable as witnesses for certain classes of ritual law (eruvs, kosher slaughter, setting aside of the challah). Their argument concludes: "If searching for chametz were a Torah-level requirement, women would not be believable [as to their testimony that such a search had been properly completed], even if they're directly involved in the task, because searching for chametz requires punctiliousness and great care. Therefore [in this case] one should worry about women's laziness more than in another case. That too is the meaning of the Jerusalem Talmud, [where it is said that] women are not believable with regard to searching for chametz, because they are lazy and search only the most minimal amount."
Now, I can't say that I'm surprised at such a statement. Misogynistic statements in the Gemara are a dime-a-dozen (as are legal innovations for the benefit of women, albeit with lesser frequency). Nor is this Tosfos a vital pillar of Jewish thought or law (though women's "unfitness" as witnesses has been a long and, actually, quite sordid chapter of halachah). (It's a very interesting Tosfos, of course, as most of them are, but not for its misogyny. I think this Tosfos might hint that "bedikas khomets" is more akin to "Pesach cleaning" than a modern-day halachist would admit.) The reason I bring it up here is that I can guess exactly how an average Orthodox rabbi would respond to it: with apologetics. Perhaps "Oh, we don't pasken like Tosfos here" (I don't know if we do or not), or "This is a metaphysical truth about women's innate capacities" or even "Who are we to criticize Tosfos"?
Here's the most cogent and satisfying way to read the statement of Tosfos with regard to women's laziness: It's wrong. Case closed. This doesn't mean that I'm arrogant, or reject the authority of Torah, or think I know more than the Baalei Tosfos. It doesn't even mean that I eat pork chops with a side of cheescake on Yom Kippur. It just means that sometimes rabbis are wrong. We gay-loving, jeans-wearing, Debbie Friedman-singing Conservative Jews certainly have our faults (hint: only one of those three activities is a sin in my book, and it's not being gay), but we can respect rabbis while calling them on their mistakes and not get tied up in knots about it.
There's a second example I'll give. It's shorter. According to halachah (the Rambam, at any rate, and I believe the Shulchan Aruch and the Remo as well; consult your local rabbi if you're brave enough to talk to her about it!), you're not allowed to have sex during the daytime or by the light of a candle. Why's that? A longish discussion in tractate Niddah of the Babylonian Talmud, starting on 16b, comes down to this: there's an angel (or demon, pick your translation) who deals with conception, and she's only active at night. Now this Gemara is not wrong, exactly. It's a convincing and consistent implication of a magical state of affairs. Unfortunately, I don't believe in the Gemara's magic. What do I do about it? Again, I could wax apologetic (it's a metaphorical apperception of a metaphysical truth! it's a guard against overpromiscuousness in the married couple! it's a segule for exciting lovemaking!), or I could say: I understand (or at least I think I do), and I don't agree. Case closed.
Elie Wiesel's Night
was written in what language?
This article in the Times (which discusses discrepancies among various translations) doesn't name the language of the original until the seventeenth (!) paragraph. (No prizes for guessing which language.)
was written in what language?
This article in the Times (which discusses discrepancies among various translations) doesn't name the language of the original until the seventeenth (!) paragraph. (No prizes for guessing which language.)
1/18/06
What did you eat that summer?
Diarrheal Illness Detected Through Syndromic Surveillance After a Massive Power Outage: New York City, August 2003.
Am J Public Health. 2005 Dec 27
Marx Ph D M P H MA, Rodriguez M P H CV, Greenko M P H J, Das M P H D, Heffernan M P H R, Karpati M D M P H AM, Mostashari M D M Sc F, Balter M D S, Layton M D M, Weiss M D M P H D
Objectives. We investigated increases in diarrheal illness detected through syndromic surveillance after a power outage in New York City on August 14, 2003.
Methods. The New York City Department of Health and Mental Hygiene uses emergency department, pharmacy, and absentee data to conduct syndromic surveillance for diarrhea. We conducted a case-control investigation among patients presenting during August 16 to 18, 2003, to emergency departments that participated in syndromic surveillance. We compared risk factors for diarrheal illness ascertained through structured telephone interviews for case patients presenting with diarrheal symptoms and control patients selected from a stratified random sample of nondiarrheal patients.
Results. Increases in diarrhea were detected in all data streams. Of 758 patients selected for the investigation, 301 (40%) received the full interview. Among patients 13 years and older, consumption of meat (odds ratio [OR]=2.7, 95% confidence interval [CI]=1.2, 6.1) and seafood (OR=4.8; 95% CI=1.6, 14) between the power outage and symptom onset was associated with diarrheal illness.
Conclusions. Diarrhea may have resulted from consumption of meat or seafood that spoiled after the power outage. Syndromic surveillance enabled prompt detection and systematic investigation of citywide illness that would otherwise have gone undetected.
Diarrheal Illness Detected Through Syndromic Surveillance After a Massive Power Outage: New York City, August 2003.
Am J Public Health. 2005 Dec 27
Marx Ph D M P H MA, Rodriguez M P H CV, Greenko M P H J, Das M P H D, Heffernan M P H R, Karpati M D M P H AM, Mostashari M D M Sc F, Balter M D S, Layton M D M, Weiss M D M P H D
Objectives. We investigated increases in diarrheal illness detected through syndromic surveillance after a power outage in New York City on August 14, 2003.
Methods. The New York City Department of Health and Mental Hygiene uses emergency department, pharmacy, and absentee data to conduct syndromic surveillance for diarrhea. We conducted a case-control investigation among patients presenting during August 16 to 18, 2003, to emergency departments that participated in syndromic surveillance. We compared risk factors for diarrheal illness ascertained through structured telephone interviews for case patients presenting with diarrheal symptoms and control patients selected from a stratified random sample of nondiarrheal patients.
Results. Increases in diarrhea were detected in all data streams. Of 758 patients selected for the investigation, 301 (40%) received the full interview. Among patients 13 years and older, consumption of meat (odds ratio [OR]=2.7, 95% confidence interval [CI]=1.2, 6.1) and seafood (OR=4.8; 95% CI=1.6, 14) between the power outage and symptom onset was associated with diarrheal illness.
Conclusions. Diarrhea may have resulted from consumption of meat or seafood that spoiled after the power outage. Syndromic surveillance enabled prompt detection and systematic investigation of citywide illness that would otherwise have gone undetected.
1/17/06
Circumcision made normal
As discussed by polemicists.
In the new issue (January 19th) of the New England Journal of Medicine, David L. Gollaher of the California Healthcare Institute reviews two histories of circumcision: Leonard B. Glick's Marked In Your Flesh: Circumcision From Ancient Judea to Modern America, and Robert Darby's A Surgical Temptation: The Demonization of the Foreskin and the Rise of Circumcision in Britain. (Glick's book was reviewed some time ago in the Forward by Jay Michaelson.)
The NEJM review isn't available on-line yet, but here are some quotes:
As discussed by polemicists.
In the new issue (January 19th) of the New England Journal of Medicine, David L. Gollaher of the California Healthcare Institute reviews two histories of circumcision: Leonard B. Glick's Marked In Your Flesh: Circumcision From Ancient Judea to Modern America, and Robert Darby's A Surgical Temptation: The Demonization of the Foreskin and the Rise of Circumcision in Britain. (Glick's book was reviewed some time ago in the Forward by Jay Michaelson.)
The NEJM review isn't available on-line yet, but here are some quotes:
Although circumcision has a long and interesting past, its historiography has suffered from a lack of objectivity. Most books and articles on the subject have an agenda, either to advocate the practice as an effective, preventive health measure or, more commonly, to attack it as genital mutilation that violates the rights of children. The books by Leonard Glick and Robert Darby are firmly in the anticircumcision camp. These authors aim to use historical analysis to strip circumcision of its medical and cultural legitimacy by exposing the myths, erroneous beliefs, and bad science that have been used to promote it.
Glick, an anthropologist with a medical degree, describes himself as "a scholarly activist" who belongs to "several organizations dedicated to ending all forms of genital injury to male and female children throughout the world." His tone is that of one who has seen the light, as he puts it, "that male infant circumcision is medically unnecessary, harmful to normal sexuality, and ethically unjustifiable." Marked in Your Flesh is less a historical narrative than a polemic. . . .
[. . .] Although [Glick] states that modern scholarship has overturned received wisdom about the authorship and provenance of the Torah, he treats the account in Genesis of Abraham as a historical record. This treatment is not trivial. Many Jews, Christians, and Muslims believe that God appeared to Abraham and told him to cut his foreskin, and that the failure of Abraham's descendants to do so thousands of years hence violates a sacred covenant. Such a belief is a matter of religious faith, however, not of documented history.
[. . .] On this topic [how circumcision came to be a widely accepted procedure in American hospitals], Glick presents few new sources or fresh insights. [. . .]
Perhaps one third of Marked in Your Flesh is devoted to reviewing the medical debate about neonatal circumcision. Professional journals have published thousands of papers about whether circumcision leads to a lower incidence of urinary tract infection, cancer, and sexually transmitted diseases. A balanced reading of the record suggests that circumcision carries both benefit and harm. It prevents rare penile cancer, but occasionally it seriously injures a baby. The American Academy of Pediatrics Task Force on Circumcision reviewed the medical literature and reported in 1999 that "existing scientific evidence demonstrates potential medical benefits of newborn male circumcision; however, these data are not sufficient to recommend routine neonatal circumcision.
The task force saw the ambiguity in the data on the health benefits of circumcision. This ambiguity only increases when one learns, for example, that in July 2005 French and South African AIDS researchers halted a large, randomized, controlled trial of adult male circumcision to reduce the incidence of AIDS after early results showed that men who had undergone the procedure had a dramatically reduced risk of contracting HIV through intercourse with infected women. Much more research is necessary, which may not bear out this result. But while reading Glick's book, one senses that the idea of benefiting from circumcision is inconceivable to him. This unwillingness to suspend the belief that circumcision is an unalloyed evil weakens Marked in Your Flesh and limits its explanatory power.
1/15/06
Keeping it real
(not by Mark Strand)
In a field
I'm not one of
the cows.
This is
always the case.
For all x not equal to me
I am not x.
When I walk
I don't stay still
and always
the air moves in
since gas is infinitely
compressible.
We all have reasons
for moving.
I've been
kicked out by my girlfriend.
(not by Mark Strand)
In a field
I'm not one of
the cows.
This is
always the case.
For all x not equal to me
I am not x.
When I walk
I don't stay still
and always
the air moves in
since gas is infinitely
compressible.
We all have reasons
for moving.
I've been
kicked out by my girlfriend.
1/13/06
A crown of thorns at Thorn Farm
If you're curious as to the meaning of אטד in this week's parshe (its only appearance in the Chumash) you might do worse than look at this Wikipedia article (in Hebrew, I'm afraid). Remember though that the Ivrit meaning of the word is not the same as its Biblical meaning. Don't forget the midrash which explains the curious name of the place at which Jacob was mourned (Thorn Farm, or גורן אטד) by saying that the descendants of Esau, Ishmael, and Keturah festooned his casket with crowns as a farm is ringed with thorns.
If you're curious as to the meaning of אטד in this week's parshe (its only appearance in the Chumash) you might do worse than look at this Wikipedia article (in Hebrew, I'm afraid). Remember though that the Ivrit meaning of the word is not the same as its Biblical meaning. Don't forget the midrash which explains the curious name of the place at which Jacob was mourned (Thorn Farm, or גורן אטד) by saying that the descendants of Esau, Ishmael, and Keturah festooned his casket with crowns as a farm is ringed with thorns.
1/12/06
Join the club
Will someone please help this man before his second thoughts about utensil-submersion become dangerous?
Will someone please help this man before his second thoughts about utensil-submersion become dangerous?
1/10/06
Permissible criticism, or O-bashing part II
Second in an intermittent series of friendly, well-meant criticism.
What do we talk about when we talk about what's wrong with Orthodoxy? A commenter on my previous post suggested that what I'm trying to do here is a "tit-for-tat" in response to Avi Shafran's Moment article "The Conservative Lie." I hope not. Shafran's argument can be summarized as follows: Conservative Judaism claims that it adheres to halachah. However, Conservative Jews and their leaders are predictably lenient, lax in observance; and cavalier about the importance of halachah to their movement. These facts show, says Shafran, that Conservative Judaism is a failure.
I doubt Shafran's interpretation of the evidence. But even taking these claims at face value, Shafran is only applying Orthodox criteria to the Conservative movement, finding the two don't match, and exclaiming, "See! Conservative Judaism is a failure!" It is a failure in Orthodox terms, but these terms are not the only valid ones. Conservative Judaism's approach to halachah is multi-faceted, and Conservative Torah scholars do not speak with one voice -- that very fact makes it very difficult to say how halachah plays a role in Conservative Judaism. (The same could be said about Orthodox or Reform Judaism, as far as that goes.) That Conservative Jews are lax in their observance, or even that they do not recognize the importance of halachah, is a problem to be solved, not an indictment of Conservative Judaism. Laxness of observance and halachic ignorance have afflicted Judaism forever. They might even be the status quo.
Shafran understands halachah according to its ultra-Orthodox interpretation: strict constructionism. But Conservative Judaism can be (and, I think, tries to be) both halachic and lenient. This dichotomy is unfathomable to Shafran, but does not make it any the less true.
The reason I'm rehashing Shafran's old essay is to try and make a stab at what I have to do to criticize Orthodoxy in useful ways. A commenter on my last post suggested that I should not judge Orthodoxy by Conservative standards. Certainly not. But, on the other hand, I can't judge Orthodoxy by Orthodox standards, for two obvious reasons: first, I'm not Orthodox; and second, because Orthodoxy might be too various to define usefully. A possible way out is sociological. Clearly, Orthodoxy plays a necessary role in Jewish society. (Not the only necessary role, or the most authentic role, but a necessary role. I make this claim because it's defensible.) If we can figure out what makes Orthodoxy necessary, and (further) point out where Orthodoxy is departing from this necessary role, this might be a useful beginning for outside criticism of Orthodoxy. In short: not to criticize Orthodoxy for what can't be by its very nature, but for what it should be and is departing from.
Maybe I've set myself too hard a task, because there's not just one necessary function which Orthodoxy performs. Let's try anyway. One definite function of Orthodoxy is to present itself as a uniquely authentic, traditional Jewish religious culture. I'm using the term "present itself" not to be snide, but to recognize that Orthodoxy is mythic (in the positive sense of myth popularized among Conservative Jews by Neil Gillman), fervently believing in its own authenticity. Whether or not that authenticity is unique is not germane to our present discussion. What matters is that Orthodoxy itself is unique by its belief in that authenticity. It's a self-creation through mythogenesis.
Call this the Myth of Religious-Cultural Authenticity. The hyphenate is important, because it's the subject of my first criticism -- which, like much else I'm saying here, is not original. Today's Orthodox Judaism is in danger of ignoring the "cultural" half of its motivating authenticity myth, and focusing exclusively on the "halachic." Not that Orthodoxy should (God forbid) change its fervent adherence to its own halachic standards (though what those standards are, how they're articulated, and how they're actually observed, is a fascinating, fraught, and ultimately very confusing terrain). But halachah to the exclusion of culture can drain Orthodoxy of what makes it convincing and meaningful not just to its followers but to its non-Orthodox observers: a central myth of traditional living as carried through the generations. (Alan Brill wrote about this in scholarly fashion in an article in Edah, which I discussed here. Also here, here, and here.)
I'd like to suggest that the sector of Orthodoxy which is managing to preserve both ends of the authenticity myth is the Charedi (and in particular the Chasidic) sector, and that modern Orthodoxy, though it is well-nigh tangent at times to my own Conservative Judaism, is most susceptible to this over-halachization I'm criticizing here.
Obviously, this is all a footnote to Rupture and Reconstruction.
Second in an intermittent series of friendly, well-meant criticism.
What do we talk about when we talk about what's wrong with Orthodoxy? A commenter on my previous post suggested that what I'm trying to do here is a "tit-for-tat" in response to Avi Shafran's Moment article "The Conservative Lie." I hope not. Shafran's argument can be summarized as follows: Conservative Judaism claims that it adheres to halachah. However, Conservative Jews and their leaders are predictably lenient, lax in observance; and cavalier about the importance of halachah to their movement. These facts show, says Shafran, that Conservative Judaism is a failure.
I doubt Shafran's interpretation of the evidence. But even taking these claims at face value, Shafran is only applying Orthodox criteria to the Conservative movement, finding the two don't match, and exclaiming, "See! Conservative Judaism is a failure!" It is a failure in Orthodox terms, but these terms are not the only valid ones. Conservative Judaism's approach to halachah is multi-faceted, and Conservative Torah scholars do not speak with one voice -- that very fact makes it very difficult to say how halachah plays a role in Conservative Judaism. (The same could be said about Orthodox or Reform Judaism, as far as that goes.) That Conservative Jews are lax in their observance, or even that they do not recognize the importance of halachah, is a problem to be solved, not an indictment of Conservative Judaism. Laxness of observance and halachic ignorance have afflicted Judaism forever. They might even be the status quo.
Shafran understands halachah according to its ultra-Orthodox interpretation: strict constructionism. But Conservative Judaism can be (and, I think, tries to be) both halachic and lenient. This dichotomy is unfathomable to Shafran, but does not make it any the less true.
The reason I'm rehashing Shafran's old essay is to try and make a stab at what I have to do to criticize Orthodoxy in useful ways. A commenter on my last post suggested that I should not judge Orthodoxy by Conservative standards. Certainly not. But, on the other hand, I can't judge Orthodoxy by Orthodox standards, for two obvious reasons: first, I'm not Orthodox; and second, because Orthodoxy might be too various to define usefully. A possible way out is sociological. Clearly, Orthodoxy plays a necessary role in Jewish society. (Not the only necessary role, or the most authentic role, but a necessary role. I make this claim because it's defensible.) If we can figure out what makes Orthodoxy necessary, and (further) point out where Orthodoxy is departing from this necessary role, this might be a useful beginning for outside criticism of Orthodoxy. In short: not to criticize Orthodoxy for what can't be by its very nature, but for what it should be and is departing from.
Maybe I've set myself too hard a task, because there's not just one necessary function which Orthodoxy performs. Let's try anyway. One definite function of Orthodoxy is to present itself as a uniquely authentic, traditional Jewish religious culture. I'm using the term "present itself" not to be snide, but to recognize that Orthodoxy is mythic (in the positive sense of myth popularized among Conservative Jews by Neil Gillman), fervently believing in its own authenticity. Whether or not that authenticity is unique is not germane to our present discussion. What matters is that Orthodoxy itself is unique by its belief in that authenticity. It's a self-creation through mythogenesis.
Call this the Myth of Religious-Cultural Authenticity. The hyphenate is important, because it's the subject of my first criticism -- which, like much else I'm saying here, is not original. Today's Orthodox Judaism is in danger of ignoring the "cultural" half of its motivating authenticity myth, and focusing exclusively on the "halachic." Not that Orthodoxy should (God forbid) change its fervent adherence to its own halachic standards (though what those standards are, how they're articulated, and how they're actually observed, is a fascinating, fraught, and ultimately very confusing terrain). But halachah to the exclusion of culture can drain Orthodoxy of what makes it convincing and meaningful not just to its followers but to its non-Orthodox observers: a central myth of traditional living as carried through the generations. (Alan Brill wrote about this in scholarly fashion in an article in Edah, which I discussed here. Also here, here, and here.)
I'd like to suggest that the sector of Orthodoxy which is managing to preserve both ends of the authenticity myth is the Charedi (and in particular the Chasidic) sector, and that modern Orthodoxy, though it is well-nigh tangent at times to my own Conservative Judaism, is most susceptible to this over-halachization I'm criticizing here.
Obviously, this is all a footnote to Rupture and Reconstruction.
1/9/06
Ebony and Ivory
Why can New York, the center of some universes, produce nothing better than the mealy, tasteless black-and-white cookie, a baked good I keep trying in vain hopes of being proven wrong, while it is Baltimore (a city I have nothing against, and in whose direction epidemiologists pray three times daily) which has given rise to the Queen of Cookies, the Chocolate-Topped? What say you, O Chocolate Lady?
Why can New York, the center of some universes, produce nothing better than the mealy, tasteless black-and-white cookie, a baked good I keep trying in vain hopes of being proven wrong, while it is Baltimore (a city I have nothing against, and in whose direction epidemiologists pray three times daily) which has given rise to the Queen of Cookies, the Chocolate-Topped? What say you, O Chocolate Lady?
Metzitzah b'peh and neonatal herpes II
Steven I. Weiss (aka Canonist) is on the case. Here's a comparison he makes:
This is a pretty good first try at a non-technical comparison of the incidence of neonatal herpes in the MBP population and New York as a whole (disregaring Canonist's terminology, which isn't what I'd use). But for an accurate, epidemiologically valid comparison, beyond nailing down the numbers as specifically as possible (Agudath Israel has an interest in exaggerating the frequency of metzitzah, for example), one would have to find a control group which is as comparable as possible to the MBP population. Ideally, that would be an ultra-Orthodox group which doesn't perform MBP. I haven't looked for differential neonatal herpes rates by religion or ethnicity, but I doubt those are followed up on by the Department of Health. A more likely tack is to find a zip code heavily populated by non-MBP Charedim and find the incidence of neonatal herpes within that area.
Taking Weiss's comparison as the best we've got, there's one thing that must be said upfront: Neonatal herpes is underreported. The question is whether the underreporting is differential, i.e., whether MBP parents (or their pediatricians) underreport neonatal herpes more than, less than, or with the same frequency as non-MBP parents (i.e. parents city-wide excluding those performing MBP). I have no idea what the answer is, but engaging in complete speculation, I would imagine that (a) the MBP population, like most Charedim, are "plugged in" to perinatal care to an extent greater than their socioeconomic status would predict, and thus (b) they would tend to report cases of neonatal herpes greater than other parents in the city, by and large, so that (c) underreporting would be greater among New York parents as a whole in comparison to MBP parents. This would overestimate any reported difference in incidence between MBP and non-MBP births.
I think there would be some interesting research here. More important than that, though, is what the DOH is doing to encourage reporting of neonatal herpes and the minimization of MBP.
Steven I. Weiss (aka Canonist) is on the case. Here's a comparison he makes:
On this issue, if we take the number of metzitzah b'feh procedures per year of 2,500, and assume one infection for those infants per year (which for whatever reason seems to be a number that everyone feels comfortable tossing around), we can compare that 1/2,500 ratio to that of the population generally. Of the roughly 120,000 New York City births per year, the Department of Health says there are roughly 30 infections, or 1/4000. So if all those numbers prove out — which for infections generally, infections in metzitzah b'feh cases, and number of procedures per year have a lot of valence — there's a difference in likelihood that could be somewhere between 33% and 50%.
This is a pretty good first try at a non-technical comparison of the incidence of neonatal herpes in the MBP population and New York as a whole (disregaring Canonist's terminology, which isn't what I'd use). But for an accurate, epidemiologically valid comparison, beyond nailing down the numbers as specifically as possible (Agudath Israel has an interest in exaggerating the frequency of metzitzah, for example), one would have to find a control group which is as comparable as possible to the MBP population. Ideally, that would be an ultra-Orthodox group which doesn't perform MBP. I haven't looked for differential neonatal herpes rates by religion or ethnicity, but I doubt those are followed up on by the Department of Health. A more likely tack is to find a zip code heavily populated by non-MBP Charedim and find the incidence of neonatal herpes within that area.
Taking Weiss's comparison as the best we've got, there's one thing that must be said upfront: Neonatal herpes is underreported. The question is whether the underreporting is differential, i.e., whether MBP parents (or their pediatricians) underreport neonatal herpes more than, less than, or with the same frequency as non-MBP parents (i.e. parents city-wide excluding those performing MBP). I have no idea what the answer is, but engaging in complete speculation, I would imagine that (a) the MBP population, like most Charedim, are "plugged in" to perinatal care to an extent greater than their socioeconomic status would predict, and thus (b) they would tend to report cases of neonatal herpes greater than other parents in the city, by and large, so that (c) underreporting would be greater among New York parents as a whole in comparison to MBP parents. This would overestimate any reported difference in incidence between MBP and non-MBP births.
I think there would be some interesting research here. More important than that, though, is what the DOH is doing to encourage reporting of neonatal herpes and the minimization of MBP.
1/8/06
Silence
Haven’t been through cataclysm, haven’t lived to see redemption,
Haven’t carved through simple moments to the bottom of their motion.
I don’t know how I’ve gotten through the day-to-day,
Not that this should hint at any courage or ennui.
No leaf bears a script. No earth-turn vibrates song.
No locust shaves a symphony from roadside corn.
Life is all that unifies, cell-in-body pulse.
There's no perfect zero. Should I add a shaky plus?
I ask the stones and pavement, stifling air, electron-work,
Tonguing waves and frozen moon, desert-wet and winter-choke:
I ask for one full full-stop, one moment ringing silence.
They call each to another and their speech is fluent muteness.
Haven’t been through cataclysm, haven’t lived to see redemption,
Haven’t carved through simple moments to the bottom of their motion.
I don’t know how I’ve gotten through the day-to-day,
Not that this should hint at any courage or ennui.
No leaf bears a script. No earth-turn vibrates song.
No locust shaves a symphony from roadside corn.
Life is all that unifies, cell-in-body pulse.
There's no perfect zero. Should I add a shaky plus?
I ask the stones and pavement, stifling air, electron-work,
Tonguing waves and frozen moon, desert-wet and winter-choke:
I ask for one full full-stop, one moment ringing silence.
They call each to another and their speech is fluent muteness.
1/5/06
The resident at rest?
Saving lives: the Sabbath as a normal workday.
MEDICINE MENSCH: Good Shabbos, I'm Off to Work
By Zackary Sholem Berger
People outside the medical field don't understand the process by which beginning doctors are trained. Were I to start this column right off and say, "I'm interviewing for residencies now" (which happens to be true), many reading this would scratch their heads, wondering when, if ever, I'll finally finish my schooling. Let me explain.
Medical school is only the first step. A medical school graduate (which I will be this May, God and registrar willing) will get an M.D., but at that point the degree is only good for hanging on a wall, getting a nonclinical job or applying for further training. Any physician who wants to practice with a state license needs to undergo such training — in other words, a residency.
Residents are apprentices in the guild system that medicine still preserves: uniforms, vocabulary and work hours all set the doctor apart. To what extent these vestiges can be shed, without disrupting the core of the physician's identity, is a discussion that has lasted the past few decades. Uniforms (the white coats) haven't been abandoned, and medicalese is a thriving dialect. But my work hours as a resident will not be the same as the chain-gang days of old, when young doctors would stagger to and from the hospital — uphill both ways — at either end of a 36-hour shift. New York's "405 regulations," passed in the 1980s, placed restrictions on residents' total work hours and required minimum rest periods. These guidelines have now been adopted nationally, so that hospitals must now keep closer tabs on how long their residents work.
Work hours of a different sort will play a role in my decision of where to spend residency. (I'm in the middle of applying to residency programs in the subspecialty known as primary care, but I haven't yet come close to deciding where I want to be. What follows are just general principles, not pros or cons of any specific program.) The issue is this: Should I work on the Sabbath?
Most people's first response is: "But I thought doctors could work on the Sabbath." Without getting pedantic about the halachic or exegetical details of the principle, it's true that "saving a life sets aside the Sabbath," as does (broadly speaking) the treatment of a dangerously ill patient. But does doctors' work always entail saving lives? And are there Jewish reasons outside of Jewish law that might make it preferable for Jewish doctors to work on the Sabbath?
A resident doctor working in the hospital on the Sabbath does not spend all 25 hours, from Friday night to Saturday night, nimbly plucking the gravely ill from the mouth of death. Some of the time is spent dealing with busywork ("Sign this!" "Send that!" "Answer that intrusive page!"), while much of the rest is spent talking to patients, other caregivers and family members about matters that, while necessary, do not mean the difference between life and death. Not everything that a doctor does during a shift is lifesaving. This is a message reinforced by the changing work hours of medicine: If doctoring is a job like any other — with shifts, overtime and holiday bonuses — why shouldn't doctors get a regular weekend, or at least one day out of seven predictably free? In other words, the Jewish legal realities of the practice of medicine (the Sabbath "work" of the doctor is more often than not something less than lifesaving), coupled with the economic and family desiderata of the young doctor (it's nice to have some regular time off), has encouraged the development of the Sabbath-observant residency program in which residents work the same number of hours as their peers, but switch off their Friday-Saturday calls to others.
This development might be taken as a sign of the salutary tolerance that American institutions demonstrate for traditional Jewish observance, something that wasn't true in our grandparents' or even our parents' generation. I don't exactly disagree with this assessment; I find these programs to be quite attractive, and I'm applying to several of them.
But there's a downside here: Gaining your soul — not having to work on the Sabbath — might mean losing the world. Part of being a doctor is the relative cushiness of the profession itself, with its good salary and societal esteem. But part of being a Jewish doctor is something different: striking a balance between God's law and human law; between death, which might strike at any time, and the call to a life of rest and contemplation, which must be obeyed one day in every seven, lest it be snowed under by the detritus of the everyday. It's like being a religious Jew: Part of keeping the commandments is knowing when not to keep them, seeing where the boundaries are and when they might (or must not) be overstepped. How can you know what it means not to eat nonkosher food if you've never seen it on a menu? Spiritual concentration requires the rigorous exercise of contact with the nonspiritual; isolation can encourage a religiosity that does not allow itself contact with the outside world.
In short, being a Sabbath-observant resident might be the best of both worlds. But I'm not sure if a Jew is supposed to allow himself that.
Chicken soup and gefilte fish, preferably in vacuum-packed containers suitable for opening in trayf, unsanitary call rooms, may be sent, general delivery, to doctor@forward.com.
Saving lives: the Sabbath as a normal workday.
MEDICINE MENSCH: Good Shabbos, I'm Off to Work
By Zackary Sholem Berger
People outside the medical field don't understand the process by which beginning doctors are trained. Were I to start this column right off and say, "I'm interviewing for residencies now" (which happens to be true), many reading this would scratch their heads, wondering when, if ever, I'll finally finish my schooling. Let me explain.
Medical school is only the first step. A medical school graduate (which I will be this May, God and registrar willing) will get an M.D., but at that point the degree is only good for hanging on a wall, getting a nonclinical job or applying for further training. Any physician who wants to practice with a state license needs to undergo such training — in other words, a residency.
Residents are apprentices in the guild system that medicine still preserves: uniforms, vocabulary and work hours all set the doctor apart. To what extent these vestiges can be shed, without disrupting the core of the physician's identity, is a discussion that has lasted the past few decades. Uniforms (the white coats) haven't been abandoned, and medicalese is a thriving dialect. But my work hours as a resident will not be the same as the chain-gang days of old, when young doctors would stagger to and from the hospital — uphill both ways — at either end of a 36-hour shift. New York's "405 regulations," passed in the 1980s, placed restrictions on residents' total work hours and required minimum rest periods. These guidelines have now been adopted nationally, so that hospitals must now keep closer tabs on how long their residents work.
Work hours of a different sort will play a role in my decision of where to spend residency. (I'm in the middle of applying to residency programs in the subspecialty known as primary care, but I haven't yet come close to deciding where I want to be. What follows are just general principles, not pros or cons of any specific program.) The issue is this: Should I work on the Sabbath?
Most people's first response is: "But I thought doctors could work on the Sabbath." Without getting pedantic about the halachic or exegetical details of the principle, it's true that "saving a life sets aside the Sabbath," as does (broadly speaking) the treatment of a dangerously ill patient. But does doctors' work always entail saving lives? And are there Jewish reasons outside of Jewish law that might make it preferable for Jewish doctors to work on the Sabbath?
A resident doctor working in the hospital on the Sabbath does not spend all 25 hours, from Friday night to Saturday night, nimbly plucking the gravely ill from the mouth of death. Some of the time is spent dealing with busywork ("Sign this!" "Send that!" "Answer that intrusive page!"), while much of the rest is spent talking to patients, other caregivers and family members about matters that, while necessary, do not mean the difference between life and death. Not everything that a doctor does during a shift is lifesaving. This is a message reinforced by the changing work hours of medicine: If doctoring is a job like any other — with shifts, overtime and holiday bonuses — why shouldn't doctors get a regular weekend, or at least one day out of seven predictably free? In other words, the Jewish legal realities of the practice of medicine (the Sabbath "work" of the doctor is more often than not something less than lifesaving), coupled with the economic and family desiderata of the young doctor (it's nice to have some regular time off), has encouraged the development of the Sabbath-observant residency program in which residents work the same number of hours as their peers, but switch off their Friday-Saturday calls to others.
This development might be taken as a sign of the salutary tolerance that American institutions demonstrate for traditional Jewish observance, something that wasn't true in our grandparents' or even our parents' generation. I don't exactly disagree with this assessment; I find these programs to be quite attractive, and I'm applying to several of them.
But there's a downside here: Gaining your soul — not having to work on the Sabbath — might mean losing the world. Part of being a doctor is the relative cushiness of the profession itself, with its good salary and societal esteem. But part of being a Jewish doctor is something different: striking a balance between God's law and human law; between death, which might strike at any time, and the call to a life of rest and contemplation, which must be obeyed one day in every seven, lest it be snowed under by the detritus of the everyday. It's like being a religious Jew: Part of keeping the commandments is knowing when not to keep them, seeing where the boundaries are and when they might (or must not) be overstepped. How can you know what it means not to eat nonkosher food if you've never seen it on a menu? Spiritual concentration requires the rigorous exercise of contact with the nonspiritual; isolation can encourage a religiosity that does not allow itself contact with the outside world.
In short, being a Sabbath-observant resident might be the best of both worlds. But I'm not sure if a Jew is supposed to allow himself that.
Chicken soup and gefilte fish, preferably in vacuum-packed containers suitable for opening in trayf, unsanitary call rooms, may be sent, general delivery, to doctor@forward.com.
George in the News
The Jewish Telegraphic Agency published a breaking news item about George der Naygeriker.
The Jewish Telegraphic Agency published a breaking news item about George der Naygeriker.
1/4/06
Oy, baby.
Two sweet.
This post will be of interest to people who have a DVD player and use it to brainwash their child with multicolored Jewish images.
OyBaby was a fun, fluffy, undemanding DVD. It was catchy from start to finish. OyBaby 2 manages to be both frumer (more gratuitous/unconvincing/sentimental references to the tradition) and more goyish (less Hebrew, more bad English translations).
This does not mean, of course, that my daughter is not fixed to the spot whenever I put the disc in the player. I enable her addiction. And anything that pleases my daughter short of firecrackers, a chainsaw, or a pork chop is still a wonderful gift. Thanks to the aunt who gave it.
Two sweet.
This post will be of interest to people who have a DVD player and use it to brainwash their child with multicolored Jewish images.
OyBaby was a fun, fluffy, undemanding DVD. It was catchy from start to finish. OyBaby 2 manages to be both frumer (more gratuitous/unconvincing/sentimental references to the tradition) and more goyish (less Hebrew, more bad English translations).
This does not mean, of course, that my daughter is not fixed to the spot whenever I put the disc in the player. I enable her addiction. And anything that pleases my daughter short of firecrackers, a chainsaw, or a pork chop is still a wonderful gift. Thanks to the aunt who gave it.
Interesting epi abstract of the week
Courtesy of your friends at the American Journal of Epidemiology.
[No comment from me, since I know nothing about this area of research. But I couldn't resist posting this.]
Association of Body Mass Index with Suicide Mortality: A Prospective Cohort Study of More than One Million Men
Patrik K. E. Magnusson 1, Finn Rasmussen 2,3, Debbie A. Lawlor 4, Per Tynelius 2,3 and David Gunnell 4
1 Department of Genetics and Pathology, Uppsala University, Uppsala, Sweden
2 Child and Adolescent Public Health Epidemiology Group, Department of Public Health Sciences, Karolinska Institute, Stockholm, Sweden
3 Division of Epidemiology, Stockholm Centre of Public Health, Stockholm, Sweden
4 Department of Social Medicine, University of Bristol, Bristol, United Kingdom
The authors investigated the association of body mass index (BMI) with suicide in a record linkage study based on the Swedish Military Service Conscription Register, the Population and Housing Censuses, and the Cause of Death Register. The cohort studied consisted of 1,299,177 Swedish men who were conscripted in 1968–1999, had their BMI measured at age 18–19 years, and were followed up for as long as 31 years. A strong inverse association was found between BMI and suicide. For each 5-kg/m2 increase in BMI, the risk of suicide decreased by 15% (95% confidence interval: 9, 21). The association was similar when subjects with mental disorder at baseline were excluded from the analysis. BMI-suicide associations were similar in relation to suicide deaths occurring in the first 5 years of follow-up (hazard ratio for each 5-kg/m2 increase in BMI = 0.84, 95% confidence interval: 0.73, 0.96) compared with associations 10 years after baseline (hazard ratio = 0.87, 95% confidence interval: 0.79, 0.96), indicating that weight loss as a consequence of mental illness does not explain the BMI-suicide association and that factors influencing BMI may be causally implicated in the etiology of mental disorders leading to suicide.
Courtesy of your friends at the American Journal of Epidemiology.
[No comment from me, since I know nothing about this area of research. But I couldn't resist posting this.]
Association of Body Mass Index with Suicide Mortality: A Prospective Cohort Study of More than One Million Men
Patrik K. E. Magnusson 1, Finn Rasmussen 2,3, Debbie A. Lawlor 4, Per Tynelius 2,3 and David Gunnell 4
1 Department of Genetics and Pathology, Uppsala University, Uppsala, Sweden
2 Child and Adolescent Public Health Epidemiology Group, Department of Public Health Sciences, Karolinska Institute, Stockholm, Sweden
3 Division of Epidemiology, Stockholm Centre of Public Health, Stockholm, Sweden
4 Department of Social Medicine, University of Bristol, Bristol, United Kingdom
The authors investigated the association of body mass index (BMI) with suicide in a record linkage study based on the Swedish Military Service Conscription Register, the Population and Housing Censuses, and the Cause of Death Register. The cohort studied consisted of 1,299,177 Swedish men who were conscripted in 1968–1999, had their BMI measured at age 18–19 years, and were followed up for as long as 31 years. A strong inverse association was found between BMI and suicide. For each 5-kg/m2 increase in BMI, the risk of suicide decreased by 15% (95% confidence interval: 9, 21). The association was similar when subjects with mental disorder at baseline were excluded from the analysis. BMI-suicide associations were similar in relation to suicide deaths occurring in the first 5 years of follow-up (hazard ratio for each 5-kg/m2 increase in BMI = 0.84, 95% confidence interval: 0.73, 0.96) compared with associations 10 years after baseline (hazard ratio = 0.87, 95% confidence interval: 0.79, 0.96), indicating that weight loss as a consequence of mental illness does not explain the BMI-suicide association and that factors influencing BMI may be causally implicated in the etiology of mental disorders leading to suicide.
1/3/06
Some healthy O-bashing, part I
Or: Friends don't let friends wreck their train.
There's a certain sort of sermon that's regularly given these days in Conservative synagogues, judging from my experience and that of a highly non-random sample of friends and acquaintances. The rabbi explains that despite the grave errors and benighted ways of Orthodoxy, he would never think of engaging in "Orthodox bashing."
Now, there's certainly a sort of Orthodox bashing which I don't want to engage in. I love Orthodoxy. Some of my best friends, etcetera. I think it's one of many authentic sorts of Judaism. (Not every sort of Judaism is authentic -- yes, I know the very word "authentic" is problematic, but I'm not going to go into that yet.) I don't want to be nasty about Orthodoxy and I certainly don't want to accuse its practitioners of anything but the healthiest and most Jewish of motives.
But I do think that bashing, done in a good-humored, respectful, and well-foundedly productive way, can be useful both to the bashee and the basher. For the sake of accuracy, perhaps, I should use another word rather than "bash," but then I wouldn't get as many people's attention. And people who have been reading this blog for a while know that bashing is not what gets done here. I could call it instead "criticism," but that's a boring word. What's a blog for if not for the judicious use of inflammatory prose?
So I think it's high time for some well-meant, well-reasoned, not unlearned Orthodox bashing. What I'm going to try to do here, over the next few days, should put you in mind of a response in Moment magazine a few years ago to the now-infamous Conservative Judaism is Wrong article by (I think it was) Avi Shafran. A Conservative rabbi wrote that Shafran's criticism was dead on, and should be accepted by the Conservative movement (at least partially) -- but, at the same time, Orthodox institutions should receive their share of healthy criticism.
I feel compelled to engage in this sort of criticism because I see Orthodoxy tearing itself apart. Its train is about to come off the tracks and explode in a fireball -- at least, ideologically speaking. And if this won't happen, something even worse could still come to pass: namely, that Orthodoxy could enjoy further sociological success (more yeshivot, more kollel students, more blat gemore learned every day, more Orthodox Jews) while continuing to be wrong in crucial, foundational ways.
Proof to come.
Update: I'm grateful to the link from On the Main Line. If I don't have a new bashpost up before Shabbos, please forgive me. I do mean to continue very soon. One response to the comments: if you refrain from criticizing group X on the basis of its defining characteristics, you make any interesting or far-reaching criticism pretty much impossible, no? That is, I don't think it makes much sense to say, "Fine, criticize Orthodoxy as much as you like. Just don't criticize those things about Orthodoxy which make it Orthodox." I take it that one of the points of criticism is to articulate a vision of group X which is at variance with group X's view of itself. No?
Or: Friends don't let friends wreck their train.
There's a certain sort of sermon that's regularly given these days in Conservative synagogues, judging from my experience and that of a highly non-random sample of friends and acquaintances. The rabbi explains that despite the grave errors and benighted ways of Orthodoxy, he would never think of engaging in "Orthodox bashing."
Now, there's certainly a sort of Orthodox bashing which I don't want to engage in. I love Orthodoxy. Some of my best friends, etcetera. I think it's one of many authentic sorts of Judaism. (Not every sort of Judaism is authentic -- yes, I know the very word "authentic" is problematic, but I'm not going to go into that yet.) I don't want to be nasty about Orthodoxy and I certainly don't want to accuse its practitioners of anything but the healthiest and most Jewish of motives.
But I do think that bashing, done in a good-humored, respectful, and well-foundedly productive way, can be useful both to the bashee and the basher. For the sake of accuracy, perhaps, I should use another word rather than "bash," but then I wouldn't get as many people's attention. And people who have been reading this blog for a while know that bashing is not what gets done here. I could call it instead "criticism," but that's a boring word. What's a blog for if not for the judicious use of inflammatory prose?
So I think it's high time for some well-meant, well-reasoned, not unlearned Orthodox bashing. What I'm going to try to do here, over the next few days, should put you in mind of a response in Moment magazine a few years ago to the now-infamous Conservative Judaism is Wrong article by (I think it was) Avi Shafran. A Conservative rabbi wrote that Shafran's criticism was dead on, and should be accepted by the Conservative movement (at least partially) -- but, at the same time, Orthodox institutions should receive their share of healthy criticism.
I feel compelled to engage in this sort of criticism because I see Orthodoxy tearing itself apart. Its train is about to come off the tracks and explode in a fireball -- at least, ideologically speaking. And if this won't happen, something even worse could still come to pass: namely, that Orthodoxy could enjoy further sociological success (more yeshivot, more kollel students, more blat gemore learned every day, more Orthodox Jews) while continuing to be wrong in crucial, foundational ways.
Proof to come.
Update: I'm grateful to the link from On the Main Line. If I don't have a new bashpost up before Shabbos, please forgive me. I do mean to continue very soon. One response to the comments: if you refrain from criticizing group X on the basis of its defining characteristics, you make any interesting or far-reaching criticism pretty much impossible, no? That is, I don't think it makes much sense to say, "Fine, criticize Orthodoxy as much as you like. Just don't criticize those things about Orthodoxy which make it Orthodox." I take it that one of the points of criticism is to articulate a vision of group X which is at variance with group X's view of itself. No?
1/1/06
Hanukkah Dinner Theater
We just got back, quite late, from a trip to Arkansas (on which more later). I lit Hanukkah candles, which I set up in such a way so that they're facing our outside window and perpendicular to the air conditioner. (They're Sabbath-type mini-candles, with a metal disc at the bottom of the wax.) Though the AC isn't on, the slight breeze blowing through its apertures has been blowing the wax away, very slowly, from the burning wicks, so that the lights stand in the center of a waxen runway, like spotlights in the snow, or a marquee for the premiere of "This Is Hanukkah."
We just got back, quite late, from a trip to Arkansas (on which more later). I lit Hanukkah candles, which I set up in such a way so that they're facing our outside window and perpendicular to the air conditioner. (They're Sabbath-type mini-candles, with a metal disc at the bottom of the wax.) Though the AC isn't on, the slight breeze blowing through its apertures has been blowing the wax away, very slowly, from the burning wicks, so that the lights stand in the center of a waxen runway, like spotlights in the snow, or a marquee for the premiere of "This Is Hanukkah."
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