Jewish leaders this week pointed to a recent independent study by Penn Medicine at the University of Pennsylvania that found little evidence to support the claim that a circumcision practice known as Metzitzah B'Peh (MBP) leads to an increased likelihood of herpes in infants.
In a study published in December last year, University of Pennsylvania's Center for Evidence-based Practice reviewed several studies linking circumcision with oral suction, a common ritual for many Orthodox Jews, and herpes simplex virus (HSV) type 1. Though four published studies since 2000 suggested that such a link does exist, Penn doctors found the evidence to be "small and significantly limited."
The study was cited in an appeal filed Monday in the U.S. Second Circuit Court of Appeals challenging a New York City Department of Health (DOH) regulation that seeks to place limits on the practice.
"We have been saying for years that the evidence attacking this religious practice is highly dubious, and now we have world class doctors agreeing with us," said Rabbi Gedaliah Weinberger , chairman emeritus of the board of trustees of Agudath Israel of America, a party in the suit. "Hard scientific evidence simply does not back up the alarmist efforts of the New York City Board of Health and others who are needlessly interfering with the fundamental constitutional rights of thousands of New Yorkers."
In the Penn study, the center explains that the evidence base is substantially limited by several factors. First, the number of events – some that date back to the 1980s – is too small to establish a causal relationship. Second, the way the cases were reported led to many questions about their validity. Third, important information about some of the cases is unknown, specifically the infection status of the mothers, which suggests that the disease could have been transmitted in other ways.
"This evidence has important limitations. The total number of cases is very small and was distributed across three countries and a fifteen year time frame. As with all case reports, they were identified and selected in a non-systematic manner and cannot be compared with a specific control group," the Penn review said in reaction to one particular study.
Last year, the DOH passed a regulation requiring rabbis, as a condition of performing MBP, to inform parents that the DOH advises that MBP 'should not be performed' because of its alleged risks, and to obtain the parents' signed consent. The regulation thus expressly seeks to deter New Yorkers from participating in this religious practice.
Several rabbis and Jewish groups later filed suit, arguing that the DOH regulation violates both the U.S. and the New York State constitutions. By forcing rabbis to communicate the DOH's subjective advice that MBP should not be performed, along with equally subjective views about unproven health risks, the DOH is imposing its own beliefs on others and violating the rights of the rabbis. Moreover, the suit casts doubt on the DOH's contention that undisputed medical facts show that MBP poses a risk, a contention now further undermined by the independent Penn study.
"The Department of Health would have the public believe there is an epidemic going on, which is not only untrue but irresponsible," said Dr. Brenda Breuer , PH.D., M.P.H., an expert witness in the case. "This is a procedure the Jewish community has been performing for thousands of years without an issue, and that has not suddenly changed in the last ten years."
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