Friday, January 24, 2020

Veggie Burgers and Defiance

Veggie Burgers and Defiance
At Jewish Newport
By Aaron Ginsburg
January 18, 2020
Edited by Beth Ginsburg Levine
also at

On Shabbat, Touro Synagogue in Newport, RI,  had a scholar in residence, Dr. Steven Schechter. Dr. Schechter is a surgeon and a teacher at Brown University. Friday night he discussed "The Efficacy of Prayer for the Terminally Ill."

On Saturday in his words of Torah, Rabbi Mandel spoke about defiance. 

‘The first thing a doctor is taught is - do no harm.

Pharoah and the midwives, Golden Haggadah
Spain ca. 1320, British Library 
“In this week's parsha, Parshat Shmot, Pharaoh tells the doctors to do harm. The midwives are commanded to kill the Jewish male children. They defy Pharaoh's orders and they don't throw the babies in the water. In addition, they feed the babies!

“The whole parsha is really about defiance in the face of injustice.

“There are many examples: Moshe's sister watches over him when he is in the water, to protect him; Moshe saves the Jewish slave as he was being beaten; Moshe rescues Yitro's daughters at the well.

“But defiance isn't easy.

“Even Moshe wanted to opt out. He told God, ‘Please find someone else.’ People don't like to leave their comfort zone to help others.

“Dr. Schechter related a story that happened to him. A medical resident was in jeopardy of being dismissed from the medical program because immigration papers were late. 

“The administrators said, ‘Well, that's one less resident.’

“Dr Schechter said, ‘No. We must help him.’ They contacted their elected officials to rescue this medical resident. 

“Let us learn from the parsha and from our scholar to be defiant in the face of injustice.”

At kiddush on Saturday, Dr. Schechter spoke about “Updates in Colorectal Cancer Risks and Screening Techniques.” This sounds dry, but it turned out to be very informative. 

Dr. Schechter spends a lot of his time performing colonoscopies, which is a screening test for bowel cancer. A screening test, he told us, must satisfy several requirements. Among those are that the screening be safe, be accurate, that the condition being tested have an effective treatment and that the screening test should be cost effective. All of these are not a given, and some screening tests may result in more harm than good. He acknowledged that there is a slight but definite risk; in the case of colonoscopies the risk is far outweighed by the amount of successful treatment.

An article in Wikipedia discusses the pitfalls of assuring that screening does less harm than good. Do false positives result in overtreatment? Since screenings are not mandatory, people with a family history may be more likely to be screened. So if women who screen for breast cancer are more likely to have the disease and die from it, this could make the test seem to cause more harm. If healthy people were more likely to take a test (healthy people might find it easier to travel to a test than unhealthy people, or healthy non-smokers might find it easier to go to a screening than non-healthy smokers, or healthy affluent people might be more likely to go than people who are not affluent.), it might mask any harm the screening might result in (by overtreatment). 

In answer to a question Dr. Schechter reviewed risk factors for bowel cancer. Smoking was one. Another was drinking more than 4 ounces of alcohol a day. Obesity was another factor. The doctor said he limits his drinking and overeating to one day a week, Shabbat. This is facilitated, he said, by the fact that his wife doesn’t cook during the week (and presumably neither does he). Veggie burgers are a staple most days! Looking at Dr. Schechter, I doubt he ever overeats!

Dr. Schechter mentioned observing a man cleaning the soot off his car while smoking. He was tempted to say, ‘Don’t you know what the soot from cigarettes does to your lungs? There is no rag that that can wipe that soot away.’ He said nothing, telling us that the reaction would be a refusal to listen. Changing behavior requires tact, time and counseling.

Some people are concerned about the anesthesia during a colonoscopy. Dr Schechter does not use any anesthesia when he has a colonoscopy himself. He said, ‘I have seen thousands of colonoscopies and know what to expect.’ He cautioned that the procedure is uncomfortable. The anesthesia itself is getting more refined, and the latest thing will enable patients to get up and on with their business right away rather than take it easy for several hours.

If a polyp is cancerous it is removed. This can be difficult since they grow out from the walls of the intestines. Since they are snipped off from the inside, there is a risk of a small puncture to the intestines. The latest technique is to have two surgeons. The second surgeon inserts a camera outside the colon, to keep an eye on what’s happening inside. 

Although Dr. Schechter didn’t avoid the technical details, his talk focused on public health. If words could cure, Dr. Steven Schechter knows what to say!

Shabbat Shalom from Jewish Newport!