Sunday, January 11, 2015

MbP and DNA Testing

So now there is DNA testing. This is the point made in a Yated article (republished in Maztav) in its crusade to change New York City’s Board of Health requirement of informed consent - warning parents of the dangers of Metzitza B’Peh (MbP). From Matzav
This extraordinary program was formed by the Rockland County Department of Health working in close cooperation with the Orthodox Jewish community. 
The DNA program - the very first of its kind anywhere - can track the source of HSV-1 by comparing samples of the virus in the afflicted infant with samples of DNA from the mohel, the baby’s parents and the main caregivers. The testing is done in the State’s Wadsworth Laboratory in Albany, the one facility in New York - and perhaps in the country - that performs DNA testing of this nature.
The model program was the brainchild of Dr. Oscar Alleyne, chief epidemiologist in the Rockland County Department of Health. Dr. Alleyne’s quest to nail down whether the practice of mbp is in fact dangerous to babies led him to reach out to Orthodox Jewish leaders in Rockland County. 
One of the claims of those who support MbP is that there has never been any direct evidence a Mohel had actually transferred (unknowingly) the herpes virus he had but which was not yet symptomatic. This was despite strong evidence that it was indeed such transfer that ultimately caused the death of some babies shortly after their Bris. A recent case where a baby was determined to have the herpes virus was found not to actually have it after this new test was administered.

The argument has always been that even in those cases where the herpes virus was shown to be the cause of death there was no direct proof that it was the Mohel that gave it to him. The baby could have contracted the virus from others herpes carriers – including the mother.

They also argued that MbP has been used for centuries as the preferred method of the Halachic requirement (as a matter of heath) to draw blood out of the circumcision wound. And it has always been without significant incident.  

MbP advocates further note that some segments of Orthodox Jewry considers MbP an essential part of the Bris, without which the Bris would be rendered invalid.  And even for many of those who did not see MbP as essential they preferred MbP – considering it a more Mehudar (ritually pure) form of Metzitza. The fact is that in the majority of cases, MbP is still used.

MbP advocates have gone to court trying to impress upon the justices the intrusion this requirement is upon the freedom of religion guaranteed by the constitution.  They claim that the bar for an exception to that right (which is used when a religious ritual is deemed harmful) has not been reached for there to be an intrusion of even warning parents about it.

If I understand correctly the court has not yet decided the issue. Although it seems to be leaning in favor of upholding Department of health requirement  of informed consent .

MbP advocates insist that the only fair way to determine whether a Mohel has transferred the herpes viros via MbP is by using the ‘gold standard’ of DNA testing . Why haven’t government health officials agreed to such testing? From Matzav
The City consistently declined to employ DNA testing, the universally recognized gold standard in determining the source of an infection. Senior health officials insisted such testing was too difficult/ expensive/inconvenient/ unnecessary. 
Well now there is a test that can be used that apparently is neither difficult, expensive nor inconvenient. The question is, is it really necessary?

Well I think it ought to be used. There is nothing wrong accuracy. As I always say, knowledge is power.

That said, I still have to wonder why it is that the MbP advocates think that a procedure that is as unsterile as MbP should be the preferred method for drawing out blood from the circumcision wound.  Anyone with the slightest knowledge of how unsterile placing a mouth on an open wound is should at least have some reservations about it.

Would any MbP advocate be pleased if a surgeon used his mouth to suction blood during surgery instead of the sterile devises normally used to do that? When one considers the lengths surgeons go to to provide sterile conditions prior to and during surgery, it is almost comical to think that using ones mouth to suction blood should be the method used.

The mouth is huge source of bacteria and viruses. How can someone object to using a mouth during surgery and yet be in favor of using it on a 8 day old vulnerable baby’s open wound?  Do they really think there is a difference between surgery and a Bris with respect to how blood is suctioned?

An open wound is easily infected. That many Mohalim rinse their mouths with an antiseptic mouthwash as a precaution does not eliminate viruses.  Only  bacteria. And I’m not even sure if it does that so well. Why not use a sterile method of Metziza that so many Poskim of the past and present have permitted? Like gauze or a pipette where there would be no direct contact.

Those Poskim surely knew that MbP was the method of suctioning circumcision blood used exclusively for centuries. And yet when it was shown that some babies died from infection after a Bris they did not hesitate to permit these alternative methods. Are we Frummer than those great Poskim? I know that there are Poskim that disagree and require MbP. But isn’t Pikuach Nefesh the best reason in the world to rely on the Poskim that permit those other methods?

One final question for MbP advocates. What will you do if DNA tests prove that a baby died because he was directly infected by Mohel that transferred the herpes viru via MbP? Will you still insist that warning parents is unwarranted?