Sunday, June 16, 2013

A Father's Day Tale

I have long been fascinated by the Biblical story of the binding of Isaac, an event known in Hebrew as the "akeda" (ah' kay DAH). Perhaps my interest was first aroused because I share Isaac's Hebrew name, Yitzchak. But the story is compelling enough that I think I'd have found my way to it in any event.

Let's review. God grants Abraham a child, Isaac, in his old age. God then assures the new father, repeatedly, that a great nation will issue from Isaac. Until one day, when, without warning, God calls to Abraham and says to him:
Take your son—your favored one, whom you love—Isaac, and go to the land of Moriah, and offer him there as a burnt offering.
(Translation adapted from the JPS Tanakh.)  Let's look at two interpretations of this shocking (even by biblical standards) demand. The first is from Rashi, the 11th century French Rabbi Shlomo ben Yitzchak whose exegesis is still the first to be studied by any student of Torah or Talmud. The original text recounts no response from Abraham to God, jumping to Abraham's immediate compliance "early the next morning". Rashi, however, relying on Talmudic and Midrashic sources, describes this dialog:
God: Take your son
Abraham: I have two sons
God: Your favored one
Abraham: Each is the favorite of his mother
God: Whom you love
Abraham: I love them both
God: Isaac.
Rashi goes on to explain that God is breaking the news to Abraham slowly, so as not to shock him. Thoughtful, no?

A very different dialog is imagined by a commentator of greater fame but perhaps less scholarly repute, Bob Dylan:
Oh, God said to Abraham, "Kill me a son"
Abe says, "Man you must be puttin' me on"
God says, "No", Abe say, "What?"
God say, "You can do what you want Abe but
The next time you see me comin' you better run"
Dylan clearly finds the idea that Abraham simply submitted to God's outrageous and immoral demand hard to swallow. He isn't alone. Earlier in the Torah, Abraham is unafraid to challenge God's decision to destroy Sodom, a city filled with strangers; surely he would do at least as much in defense of his own child!

In the end, of course, Isaac is saved by the voice of an angel who commands Abraham to stay his hand just as it is poised over his bound and vulnerable son. But the fact remains that, as the Torah recounts the story, Abraham was ready and willing to end his son's life there on Mount Moriah. Was Abraham's compliance a show of faith that God would ultimately retract his vicious command, or did Abraham simply subordinate his own sense of morality (not to mention his instincts as a father) to the will of the God he worshipped?

It is on this point that the fundamentalists part company with the rest of us. No God can command us to behave immorally; indeed, that is the litmus test for any God we might imagine. And yet, even today, God commands fathers to sacrifice their sons, tragically failing to intercede at the critical moment as He did with Abraham. But the father's hand doesn't just strike down the son; it sweeps away the Passover celebrants, the teenagers out for a night of dancing, the mothers and fathers working at their desks on a high floor of New York's tallest towers. Because in the fundamentalist doctrine, morality is a purely secular conceit: it is only the will of God that matters.

Modern Orthodox scholar Rabbi Shlomo Riskin writes of the akeda, "[T]he entire story comes to teach that our G-d of ethical monotheism would never expect a parent to slaughter his son in His name". In other words, maybe Abraham was misled precisely so that we should not be. Whatever our idea of God, even His will cannot trump our duty of moral behavior. History has shown us only too clearly what happens when those priorities are inverted.

Thursday, March 21, 2013

Two Presidents

Tonight, two presidents are sharing dinner in Jerusalem. One, Shimon Peres, is among the last of his breed: the founders of his nation, the lions of Labor Zionism who wrested the Jewish homeland back from the hostile grasp of nature, Arab armies, and a criminally negligent god. The other: Barack Obama, the herald and voice of a new generation, a man who broke the hold of corrupt old white men on the highest office of the greatest nation the world has ever seen. Two presidents, two men who in age, appearance, and biography could hardly be more different, and yet who share an inspiring vision of the Middle East only they seem able to clearly articulate.

Peres spent much of the 90s articulating his vision of a "New Middle East", one in which Israelis and Arabs would form an economic alliance, creating regional prosperity and hope and engagement for the people living there. Such a partnership could only be realized, of course, in the context of a multilateral agreement bringing peace to Israel and its neighbors. After the failure of Oslo, Peres was roundly derided for this ideal, as though the evil and cynical manipulation of the process by Arafat and his terrorist cohort was somehow enabled by those who had invested their hopes in it. And yet now, as President—a largely ceremonial post—Peres enjoys a degree of popularity that evaded him in his decades in politics.

In a speech today aimed at the Israeli public—one which could hardly have been delivered to the cynical dogmatists of the Knesset—President Obama's message recalled his dinner host's New Middle East vision.

So if people want to see the future of the world economy, they should look at Tel Aviv, home to hundreds of start-ups and research centers. Israelis are so active on social media that every day seemed to bring a different Facebook campaign about where I should give this speech.
That innovation is just as important to the relationship between the United States and Israel as our security cooperation. Our first free trade agreement in the world was reached with Israel, nearly three decades ago. Today the trade between our two countries is at $40 billion every year. More importantly, that partnership is creating new products and medical treatments; it’s pushing new frontiers of science and exploration.That’s the kind of relationship that Israel should have -- and could have -- with every country in the world. Already we see how that innovation could reshape this region. There’s a program here in Jerusalem that brings together young Israelis and Palestinians to learn vital skills in technology and business. An Israeli and Palestinian have started a venture capital fund to finance Palestinian startups. Over 100 high-tech companies have found a home on the West Bank, which speaks to the talent and entrepreneurial spirit of the Palestinian people.
 You know, one of the great ironies of what’s happening in the broader region is that so much of what people are yearning for -- education, entrepreneurship, the ability to start a business without paying a bribe, the ability to connect to the global economy -- those are things that can be found here, in Israel. This should be a hub for thriving regional trade and an engine for opportunity. Israel’s already a center for innovation that helps power the global economy. And I believe that all of that potential for prosperity can be enhanced with greater security, enhanced with lasting peace.
Thanks to Shimon Peres, this is a message that is already familiar to Israelis, and resonates strongly for those with the imagination to share it. There is a long row to hoe before it can become reality, and some obstacles seem insurmountable. The Palestinians continue to deny history, to educate their children to hate Jews, and to embrace violence as a channel for their frustration. But as these two great leaders persist in reminding us: we cannot allow our anger over the past, however justified, to destroy our future.

Sunday, March 17, 2013

Nanny Knows Best

Warning! Things that are good for you in small amounts may be bad for you in large amounts!

Shocked? No? Well, congratulations, you're one step ahead of the media, which has apparently just discovered the "too much of a good thing" phenomenon. Always reaching for titillating new ways to fill air time in between natural disasters and terrorist attacks, news outlets are focusing on prescription drugs, and opiates in particular, as the latest Terrifying Thing That Might Kill You At Any Moment.

Which is not to say there isn't a problem. Health advocates, such as these officials in Florida, have observed that the number of deaths due to prescription drug overdose far exceeds that of deaths due to illegal drugs such as cocaine and heroin (or, of course, marijuana, which has resulted in exactly zero overdose deaths). In 2009, approximately 38,000 people nationwide died as a result of drug overdoses. If Florida's figures are consistent with national trends, we can assume that about 28,000 of those deaths were due to prescription drugs.

28,000 deaths; 28,000 tragedies. Every year. So yes, there's a problem.  But as we search for solutions, let's not overlook another important number: 100,000,000. One hundred million is the number of Americans suffering from chronic pain, for which prescription drugs are the most effective legal path for relief. Put another way: every day, one in three of your fellow citizens goes to work, plays with grandchildren, runs errands—in other words, lives his life—while in pain. For every terrible, wasteful death associated with prescription medications, there are thousands of individuals whose lives would be shattered without them.

Unfortunately, chronic pain is so dog-bites-man. Boring. CNN isn't going to get all hot and bothered about some guy who doesn't lose his home because pain meds enabled him to work—not when they have dead celebrities, real ad-inventory movers like Whitney Houston, Heath Ledger, Brittany Murphy, Anna Nicole Smith, or Michael Jackson.

Now that's a story!

But, hey, don't take the talking heads' word for it. Bring on the journo-docs! Under the hot lights, even generally responsible types, like CNN's Sanjay Gupta, tend to over-focus on the risks at the expense of the context. The point out that, for example, the FDA believes we're in the midst of "an opioid epidemic". But when the context is tens of millions of people suffering chronic pain or other symptoms relieved by prescription drugs, context matters. Because, if you take these arguments to their ad absurdum conclusions, the only "logical" choice is to prohibit or severely restrict access to the meds that provide relief for all those millions of everyday people.

Think nobody is calling for that? Think again. Mayor Michael Bloomberg, fresh off his victory against the corporate titans of Big Cola, is now taking on New York's addiction problem by moving to limit the supply of pain medications in city hospitals. (This effort, and another in Colorado, are focused on emergency room care specifically, which seems prima facie reasonable, until one considers the huge number of patients still receiving their primary care in ERs.)

Of course, once they're on a roll, it's hard to slow the journo-docs and the politinannies down. After all, other drugs can also be dangerous, right? Gotta make sure people can't get their hands on them. Recently, my daughter had a nasty sinus headache. Due to the late hour, I had to drive all over the county to find an open pharmacy that would sell me the decongestant pseudoephedrine (which is also a key ingredient in one recipe for methamphetamine), thanks to regulations that inconvenience patients a lot more than they trouble drug dealers. (Did I mention that there are other recipes for meth that don't require pseudoephedrine at all?)

Eventually, the medical chicken littles inevitably begin to bump into one another. In a recent piece in the Jewish Journal of Los Angeles, columnist Dr. Albert Fuchs wrote of the dangers of the common, effective cough suppressant, Tessalon.
Coughing can be very disruptive to work and to sleep, and patients can be desperate for relief. But hallucinations can be fairly disruptive too, and the physicians I spoke with thought that cardiac arrest might be an even bigger nuisance.
Wow: take a little yellow pill, have a heart attack. Scary stuff. Except that none of the sources he cites actually warn of any such risk in adult patients taking the appropriate dosage. Dr. Fuchs goes on to quote one such source (out of context) suggesting that codeine might be preferable to Tessalon (again, the original context is children, whereas Dr. Fuchs is specifically referring to adults).

Hey—wait a minute. I thought the problem was opiates. Codeine is an opiate, right? You bet it is. You see, once you take away one type of medication because it's dangerous, you have to offer another to treat the symptoms for which the original drug was prescribed. And then... uh oh! That one's dangerous too; maybe the old drug was better. Apparently, in pharmacology, as in life, the grass is always greener on the other side of the regulatory fence.

The vast majority of addicts did not get that way following their doctor's advice or carefully reading labels. Unlike those with chronic pain, or persistent cough, those addicts are suffering (at least to some extent) as a result of their own choices. Prescribing meds, taking them, or giving them to your children are fraught activities deserving of respect. Extra caution should always be exercised when giving drugs to children, and both children and adults should always be concerned about proper dosage and interactions.

But the solution isn't to limit access to drugs that are effective and safe when used properly. Instead, let us demand that pharmaceutical firms label appropriately, and doctors counsel wisely, avoiding hyperbole and fads, so that we may permit adults the dignity of making informed choices about their own care.