Metzitzah b'peh

• The Politicker

The city's Health Department released an open letter from Commissioner Tom Frieden to the Jewish community today, in which he writes that a circumcision practice called metzitzah b’peh is definitely tied to several herpes infections in babies, and one death -- but that the city will not ban the it.

Frieden is not known for his ambivalence on public health issues. Here, public health experts called for banning the practice, while the Chasidic communities involved cried religious freedom. His mixed feelings about the compromise result are on full display in this passage from the letter:"

The Department has reviewed all of the evidence and there exists no reasonable doubt that metzitzah b’peh can and has caused neonatal herpes infection. We have always maintained that it is our preference for the religious community to address these issues itself as long as the public's health is protected. While some medical professionals and others in the Jewish community have called on the Department to completely ban metzitzah b'peh at this time, it is our opinion that educating the community through public health information and warnings is a more realistic approach."

This will come as a relief to many Orthodox leaders, particularly in the Lubavitcher community, but really most of the way across the Chasidic sects, where the practice is common. (Less of a relief to Christopher Hitchens, who wrote against the practice in a piece headlined "Cut It Off: Another Disgusting Religious Practice.")

The softly, softly approach is a bit of a departure for Frieden, a public health hardliner who considers tobacco executives evil. Here, even the case of the mohel most directly tied to the illnesses has been referred to a rabbinical council, which could conceivably permit him to resume the practice. The public information campaign will be in English, Yiddish, and Hebrew; but the Chasids aren't flourishing because of their openness to changing their ways.

People involved in the discussions around the case say the Health Department got legal advice that they could spend years in court trying to ban a religious practice, and might loose on religious freedom grounds. (Though clearly the state has some right to govern the way people treat their children.) There was always a political aspect to the story as well, as Bloomberg aides scrambled to mollify the communities involved in an election year.

Frieden spokeswoman Sandy Mullin offered another objection to banning something done at private gatherings, brises: "We can't enforce it."

• From N.Y.C. Department of Health website:

How metzitzah b'peh spreads herpes:
In metzitzah b'peh, the mohel places his mouth on the freshly circumcised penis to draw blood away from the cut. If the mohel is infected with oral herpes (as most adults are), metzitzah b'peh can expose the infant to the herpes virus. While severe illness associated with this practice may be rare , there is a definite risk of infection.
Oral herpes spreads easily through saliva, especially when saliva touches a cut or break in the skin, such as during metzitzah b'peh.Most people with oral herpes don't know they are infected and don't have symptoms. Even without symptoms, however, people can spread the infection.
Because the immune system of newborns is not developed enough to fight serious infection, herpes infections pose grave risks to infants.
There is no proven way to reduce the risk of metzitzah b'peh:
Although a mohel may use oral rinses or sip wine before metzitzah b'peh, there is no evidence that these actions reduce the spread of herpes. A mohel who takes antiviral medication may reduce the risk of spreading herpes virus during metzitzah b'peh, but there is no evidence that taking medication eliminates this risk.