The following is a copy of a letter that sent to the Jewish Star in regards to the article written by Avi Billet posted on YWN [link below]. It is unknown if the letter will be printed by the Jewish Star, but the doctor emailed it to YWN as well:
To the Editor:
By calling for different standards in the way brisim are performed, it seems that Avi Billet has fallen into the same trap that many others have in recent years – using current medical knowledge and practice to invade areas of psak halacha and minhag yisroel.
Rabbi Billet himself admits, in the first sentence of his February 10 article, that bris milah carries a “surprisingly low risk rate”. Surprising, indeed. The rate of surgical site infections in the United States ranges from 2 to 5 percent. Extrapolated to the newborn boys in my pediatric practice, one would have expected at least seven babies with bris complications, chas v’shalom in the past year. I have seen two or three in the last five years.
Anyone who has been in the operating room knows that the precautions taken to prevent infection are numerous, and may even seem excessive to the lay observer. If a surgeon even touches the back of his colleague’s sterile gown he must re-glove. Antibiotics are routinely administered at the beginning of each procedure, and the surgical wound is usually sutured closed. It would seem from Rabbi Billet’s article that even he does not adhere to this level of infection control. How the, can we explain this discrepancy between bris milah and other surgeries?
The reason, I believe, is that bris milah is not a surgical procedure. It is a mitzvah. The way by which it is performed is dictated by halacha and minhag. “Shomer mitzvah lo yaida davar rah”. While we need to be aware of developments in the medical field that are relevant to milah, the medical profession dare not overstep this boundary. Just as with fasting on Yom Kippur, the medical opinion needs to be provided by the physician, but the final ruling is subject to the algorithm in the Shulchan Aruch. While sterile technique is not in opposition to halacha, turning the Kisei Shel Eliyahu into an operating table creates a slippery slope and a threat to the institution of milah as it is viewed by the masses.
As for metzitzah, many poskim have sanctioned the use of a pipette in order to reduce the risk of infection. Most of the Gedolei Yisroel, however, have urged that the practice metztitzah b’peh should be continued, notwithstanding several cases of complications which have occurred in recent years. We find that even though the medical basis for metzitzah b’peh is unclear, the gedolim allowed its practice on Shabbos, despite the possibility of chilul shabbos shelo b’makom sakanah. They recognized the dangers of tampering with minhag yisroel. Certainly, the risk of infection is not altered by having the father perform metzitzah; he may be more infectious than the mohel.
As a pediatrician, I will continue to provide my medical opinion only when sought by a rav or a mohel. Parents should consider their own minhagim and involve their rav when selecting a mohel, rather than choose one based on his medical expertise.
David M. Klein, MD FAAP
Boro Park Pediatric Associates, PLLC
(Residing in Bayswater, Far Rockaway)
LINK to YWN article.