Culture Clash Over Brit Ritual

Undergirding the current standoff between the fervently Orthodox community and the New York City Department of Health over a controversial circumcision practice appears to be a gulf of cultural difference and a fundamental misunderstanding of the disease at issue.

That is one of the conclusions drawn from voluminous correspondence between members of the haredi community and city health officials obtained by The Jewish Week through a Freedom of Information Law request filed in October.

According to the health department, metzitzah b’peh, or oral suction of the circumcision wound, has been proven to transmit herpes type 1 from mohel to newborn, resulting in severe illness and in at least one case, the baby’s death.

But the fervently Orthodox community insists that the Health Department has not proven anything, and views attempts to discourage the practice as an unwelcome governmental intrusion into what is time-hallowed, and should be a private, religious act.

The correspondence reveals a sense of bewilderment and frustration from Dr. Thomas Frieden, the city health commissioner, over the furious opposition he has encountered.

Yet interviews over the last few months with members of the chasidic community — mothers and fathers of boys who have had metzitzah b’peh, and pediatricians who work in that community — have also made clear an enormous sense of doubt and suspicion of the health department’s findings and motivation.

In the year since news of the health department’s investigation of a mohel believed to have infected babies, occasional attempts have been made to organize protests.

The city’s 311 information and complaint line fielded a barrage of calls on Aug. 9, 2005, for example, from people from Brooklyn, Rockland County and even upstate New York to complain about government interference.

Isaac Reisenfeld of Division Avenue in Williamsburg, Brooklyn, was one of 107 people to call 311 that day. He called “to ask the Department of Health not to prohibit circumcision, as it is very necessary for the Orthodox Jews,” according to health department records.

An anonymous caller “complained about the fact that the Department of Health stopped someone from practicing their religion by circumcising,” according to the 311 operator’s log.

At no time, however, has the health department suggested that it would try to ban circumcision in general.

“This is America, not Russia,” said another caller, who did not leave his name. “The Department of Health should not mix into religious process.”

Another caller termed it “racially biased.”

Misinformation about the health department’s intentions seems rife among the fervently Orthodox.

David Zwiebel, an executive at Agudath Israel of America, which represents the interests of the fervently Orthodox community, said the reason may be the byproduct of efforts to organize community protests.

“Whether intentional or otherwise, there have been efforts to galvanize the community,” he said. “Sometimes when you speak in shorthand or dramatic terms, or wish to impress upon people the urgency of a situation, people may walk away without a precise understanding of what is being talked about, but believing that in some way the government is coming in to regulate bris milah. That probably is the source of this kind of rhetoric.”

Others say the misinformation starts at the top.

“The lack of understanding among leaders of this community is truly outrageous,” said Dr. Jonathan Zenilman, chief of infectious diseases at Johns Hopkins Medical Center.

As an example, he cited a suggestion by Agudah in a letter last week to the Department of Health that mohels believed to have transmitted herpes to infants not be banned from doing metzitzah b’peh, but instead that the anti-viral drug acyclovir be topically applied to the circumcision wound or that it be taken by the mohel orally.

“The Agudah’s proposals demonstrate that they don’t understand this disease process,” Zenilman said. “Local application of acyclovir doesn’t work. It is not used by clinical experts for treatment, let alone prevention of transmission.”

And, he said, herpes-infected adults taking acyclovir orally is proven to be 90 percent effective in preventing symptomatic transmission among adult partners, but effective only half the time in the actual transmission of the virus.

Furthermore, Zenilman said, these are adult sexual partners with mature immune systems who were studied, not newborns.

“One of the things that gets consistently overlooked is that the infant is considered an immuno-suppressed host in terms of susceptibility to infection,” he said. “That’s why in this population this infection is a devastating disease.”

Meanwhile, some representatives of the fervently Orthodox community are ramping up a campaign to get Frieden taken off the metzitzah b’peh issue.

In a meeting last month, representatives of the Central Rabbinical Congress of the U.S.A. and Canada, a rabbinical court, asked Frieden to recuse himself and turn the matter over to the state’s health commissioner.

A Satmar source who asked not to be named said upon hearing the suggestion, Frieden told the representatives that would be like the rabbis turning their authority over to priests, and walked out of the room.

And on Jan. 17, a delegation of Satmar rabbis went to Albany to appeal directly to Dr. Perry Smith, the state’s chief epidemiologist in the Department of Health.

A call to Smith’s office was not returned by press time.

The city’s Department of Health is also working to add neonatal herpes to the list of diseases doctors are required to report to the city upon diagnosis. Health authorities hope this will help them learn just how common the disease is, including cases that may be due to metzitzah b’peh.

The city Board of Health held a little-publicized public hearing on the proposal on Jan. 19; no members of the public came. The board, composed of 10 mayoral appointees and chaired by Frieden, will revisit the issue on March 16 and could recommend that neonatal herpes be added to the list of diseases. That recommendation would likely become law.

Agudah submitted written comments to the Jan. 19 meeting supporting the proposal.

In an interview, Zwiebel said mandated reporting of neonatal herpes “will, I hope, confirm what we hear from pediatricians who serve the community, which is that this is an extremely rare phenomenon.”