'Oral Suction' Provides Anti-circumcision Activists With Dubious Ammunition

The link between metzitzah b'peh and fatal herpes is not as 'scientifically' obvious as one may think.

Rabbi Avi Shafran
Avi Shafran
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A Jewish baby at his circumcision.
A Jewish baby at his circumcision. Credit: AP
Rabbi Avi Shafran
Avi Shafran

If an anti-circumcision activist ever needed a “poster child” for his cause, the obvious candidate would be metzitzah b'peh, the “oral suction” that, in some Jewish communities, follows a circumcision.

Jewish law mandates suctioning blood from the circumcision wound (to draw away any noxious elements). While many religious authorities sanction using a pipette or even just absorbent gauze, many Hasidic and other communities, citing mystical texts, insist on metzitzah b'peh (henceforth, MBP).

Bizarre? To some, surely. No stranger, though, than some of our own society’s penchants, like tummy-tucks or facelifts, would seem to a visitor from a saner planet.

Cosmetic surgery carries medical risk. But Western society greatly prizes beauty (or its conception of it). Religious practices, not so much.

Which is part of the reason there has been an onslaught against MBP in recent years. Some baby boys who had undergone the rite were diagnosed with herpes simplex virus type 1, the virus that causes cold sores – and which is carried by a large majority of adults. HSV-1 causes discomfort in adults, but in a baby the infection can be more dangerous, even, on rare occasions, fatal.

Some medical experts insist that MBP is the obvious culprit. Relying on those experts, former New York Mayor Michael Bloomberg, who famously crusaded against salt, soda and sugar, enacted a regulation requiring mohelim, or ritual circumcisers, to obtain written consent from parents, confirming they are aware of the dangers of MBP. Leave aside the constitutional legality of compelling speech (the mohelim do not believe that MBP is unsafe), alarm bells rang in some circles because, for the first time ever in the United States, an aspect of ritual circumcision was being regulated.

The current New York City administration of Bill de Blasio plans to rescind this requirement and focus instead on “education” of the Jewish community about herpes rather than on regulating the ritual.

If that education, though, maintains the assertion that MBP represents a danger to infants, it will be miseducation.

Dr. Daniel S. Berman is Chief of Infectious Diseases at New York Westchester Hospital, Dr. Brenda Breuer is Director of Epidemiologic Research at Beth Israel Hospital and Professor Awi Federgruen is an expert in quantitative methodology teaching at Columbia University. Self-described Modern Orthodox Jews, none of them considers MBP to be religiously required. But all three, as a matter of principle, have spoken up – putting themselves in the firing line of colleagues who can’t imagine that MBP doesn’t pose some terrible risk – and have publicly challenged the claim that the rite represents any quantifiable danger to babies.

To be sure, there is a slightly increased danger of any infection at the site of any open wound – including a MBP-less circumcision. But nowhere near the increased risk to life and limb attendant to, say, skiing, bicycling or crossing a Manhattan street – even when the “walk” sign is on.

Over the past two years, according to The Forward, E. Oscar Alleyne, director of public health planning in Rockland County, New York, conducted DNA tests – the only conclusive way of identifying the source of a herpes infection – on three mohelim who performed MBP on babies that later tested positive for herpes.

The result of one investigation was inconclusive. The results of the other two showed that the two mohelim were clearly not the source of the disease.

That, of course, doesn’t prove anything. But it surely shocked those who cavalierly assumed that when an MPB baby developed herpes, the culprit was “scientifically” obvious.

A New York City health department spokeswoman, referring to the appearance of herpes in Jewish newborns, issued a challenge:

“Any hypothesis to explain these infections needs to explain why these infections are HSV-1 [commonly residing in the mouth], occur on the genitalia, occur in newborn baby males but not females from Jewish families practicing [MBP], are clustered in a single Brooklyn zip code where there are no female infant herpes infections, have occurred in babies born to women who do not have HSV-1 infection, and occur within a time frame consistent with transmission during circumcision.”

Reasonable questions. And an entirely plausible answer is that herpes can easily be transmitted by a caregiver or family member shedding the virus who had recently touched his or her mouth, that a recently circumcised baby is more vulnerable to infection at the circumcision site, and that babies tend to get diapered several times a day.

Responsible mohelim take the precaution of disinfecting their hands before each circumcision (and rinse their mouths well with antiseptic before performing MBP). The way to reduce the tiny number of herpes infections in Jewish newborn boys to zero might just be for the boys’ caretakers to take similar steps before diapering the babies.

Rabbi Avi Shafran serves as Agudath Israel of America’s director of public affairs and blogs at www.rabbiavishafran.com. His most recent collection of essays is entitled “It’s All in the Angle” (Judaica Press, 2012).

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