Letters to the Editor

A Loser in “Jewish Geography”
Devora Lifshutz’s article “Reflections on Being a Loser in Jewish Geography” (winter 2008) leaves me wondering what would be considered appropriate to say to a new acquaintance. “Where are you from?” is a typical question. If that question is not “safe,” which question is? It would seem that any question one picks may cause embarrassment, but if one does not ask any questions, how does one indicate friendly interest in learning about the other person?

Emil M. Friedman, PhD
Waterbury, Connecticut

To Vaccinate or Not to Vaccinate?
I read with great interest “Halachic Aspects of Vaccinations” by Dr. Edward Reichman in the winter 2008 issue. As a chiropractor working with many Orthodox families who question whether to vaccinate their children, I found his points relevant and most interesting.

If one were to accept all of his postulates as true, his conclusions would be hard to deny. However, a few points bear mentioning.

The most common concern heard among people is the supposed link between vaccinations and autism, which Dr. Reichman mentions but tosses aside as unproven. However, an article in the Journal of American Physicians and Surgeons (spring 2006) states that very specific neurodevelopmental disorders are associated with thimerosal-containing vaccines. An article like this cannot be discounted. Regarding the past historical triumph of vaccinations, there are many studies that question whether some of these diseases were already on the decline at the time the vaccines were instituted.

Even if some vaccines were helpful, does that mean that a person must subject his child to everything out there? The hepatitis vaccine is given routinely to newborns. What is the purpose of this? Since there is a test to see if the mother is infected, why not test the mother during her prenatal care and then vaccinate the newborn if necessary? Why subject a newborn to a potential horrific side effect when there is a way to tell if the vaccination is necessary in the first place?

Further, what about the effect of all the cumulative vaccines, as more seem to be added yearly? Also, why vaccinate for diseases such as chicken pox, which is generally not a serious illness?

I would suggest that the halachic question of vaccination be broken down a bit further; moreover, we should not lump polio, chicken pox and hepatitis into one barrel. They are all vaccines, but not all vaccines are equally valid or reliable, and they shouldn’t be painted with the same halachic brush.

Harry Schick, DC
Highland Park, New Jersey

Dr. Reichman Responds
I thank Dr. Schick for his thoughtful letter, which represents the thoughts of others with whom I have spoken since the publication of the article. As I begin to put finger to keyboard to compose this response, another window is open on my desktop with an article from today’s news, entitled “Study Shows No Link Between Autism and Vaccines: Italian Study Rules Out Thimerosal Fears.” Therein it is written:

“Put together with the evidence of all the other studies, this tells us there is no reason to worry about the effect of thimerosal in vaccines,” said the new study’s lead author, Dr. Alberto Tozzi of Bambino Gesu Hospital in Rome.

I am not saying that this is the final word, but evidence is clearly mounting in one direction. Dr. Schick cites one article that found a relationship, though not causality, between very specific neurodevelopmental disorders and thimerosal- containing vaccines.

Herein lies the complexity. Today, everyone has equal access to the intricate world of scientific research. In moments, with the stroke of a few keys and a few clicks of the mouse, anyone can summon dozens of articles from the world’s premier scientific journals on any topic. There will often be articles that support a variety of positions. One article, however, does not medical fact or dogma make. Opinions evolve with the accumulation of multiple studies, each analyzed on the merit of its design, execution and subsequent corroboration. Just as a layperson cannot render a halachic decision from a word search on Bar-Ilan University’s Jewish Database, one cannot adequately assess the risks and benefits of vaccination through an Internet search.

Dr. Schick asserts that “an article like this cannot be discounted.” I respectfully disagree. If the article’s conclusions cannot be repeated; if the study design was flawed; if the study population was not statistically significant or if the totality of mounting evidence is against its conclusions, then indeed it can be discounted.

I agree with Dr. Schick that the halachic question needs to be “broken down a bit further,” and that all vaccines should not “be painted with the same halachic brush.” This is indeed the case to some extent, as evidenced in the literature cited for reference at the end of my original article. The article was intended for merely broad strokes, with the finer details left for further study in the halachic literature. Admittedly, there is further halachic analysis that could be done.

Questioning conclusions and suspending acceptance pending challenge are the hallmarks of the halachic mind. Dr. Schick’s thoughtful and intelligent comments are not only welcomed, they are encouraged. However, intellectual honesty likewise compels us to know the limits of our expertise, and the misinterpretation or misapplication of science by some (excluding Dr. Schick) to the possible detriment of our families and our communities is deeply troublesome. To be sure, the medical profession is far from perfect, but, to borrow from a halachic adage, “ein lerofeh elah ma sh’einav ro’ot”—the medical profession relies on the best available evidence. While the conclusions of the Centers for Disease Control and Prevention are not in the realm of binding pesak, they nonetheless represent the efforts of years of intense research by some of the brightest minds in the medical community, and should be given due respect. However, as human beings, medical professionals are not immune to the possibility of error. Is it possible that there are flaws in their approach? Absolutely. Must we constantly re-analyze and revisit the data and revise the policies? Yes. The history of science, and in particular the history of pharmaceuticals, are replete with stories of the introduction of “miracle medicines” that were subsequently rescinded from circulation due to unforeseen complications. However, the scientific theory of vaccination is unequivocally based on terra firma, and while there are clearly circumstances where vaccination should be withheld, these exceptions should be rare and discussed with medical professionals.

Thoughtful, nuanced, selective use of vaccinations by those trained to interpret the data or by those who have medical or personal reasons to refrain from vaccinations is one thing; mass hysteria, or refusal to vaccinate based on popular articles, hearsay and unproven assumptions is quite another.

I consider this exchange somewhat analogous to vaccination itself. My first article provided immunity to some, but this exchange is a form of booster shot. More discussion is needed on this issue, and further booster shots may be in order. Yet, despite the best practice and the best intentions, there will always be a percentage of people for whom the immunization (either physiological or halachic) is not successful.

This article was featured in the Summer 2009 issue of Jewish Action.
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