This is a very interesting move by the RCA. It’s implications will be interesting to watch as the issue of the direction of the organization has been one many have watched closely since the appointment of R. Shmuel Goldin. I cannot speak from any personal perspective on R. Herring or this issue as it is too early to know the whole story.
In the following opinion piece, the question is posed about keeping a drug on the market because it helps some people but not others. He is arguing that no matter how much we might be able to predict prognosis of cancer patients, we have to be reminded how each case is different. Since a prognosis is an average, there are some who outpace the average significantly. Unfortunately, with the increased concern for fiscal responsibility over patient choice, health care is losing the argument about individualized care.
Last year, the FDA began the process of revoking Avastin’s approval for breast cancer. Some leading oncologists applauded the decision, arguing that, for the average patient, Avastin doesn’t work very well and has significant side effects.
Patient advocates and thousands of women who credit their survival to Avastin argue that it’s unfair for the FDA to remove one of the few available options for patients diagnosed with terminal cancer. They’re right.
Avastin originally hit the market in 2004 to treat other cancers, and in 2008 the FDA conditionally approved it for breast cancer. Initial testing showed that, on average, Avastin didn’t lengthen patients’ overall survival time. But it did slow tumor growth, giving many patients a longer “progression-free” survival. What this means is that dying patients get a precious few extra months of quality time they can spend with family and friends, travel rather than being confined to a bed, or get their personal effects in order.
A small percentage of patients taking Avastin have been cured of their breast cancer. But the drug’s permanent approval hinged on the results of two additional clinical studies focusing on the progression-free survival end-point experienced by the majority of Avastin users. As before, neither study found an increase in overall survival, but they did record modest gains in progression-free survival—about five and a half months longer than those on the alternative treatment. That wasn’t enough for the FDA, so the agency moved to revoke Avastin’s approval for breast cancer last July…
When well-known scientist Stephen Jay Gould was diagnosed with a rare form of lung cancer in July 1982, he was told the diagnosis meant a median survival time of just eight months. His doctor gave up on him. But he lived another 20 years.
“Means and medians are the abstractions,” he wrote in Discover magazine in 1985. “Therefore, I looked at the mesothelioma statistics quite differently—and not only because I am an optimist . . . but primarily because I know that variation itself is the reality.”
Like Gould’s doctor, the FDA and its technocratic supporters are giving up on breast cancer patients because of their slavish obsession with median response rates. Everyone can agree that, on average, Avastin does not extend most patients’ life expectancy. But some patients have responded incredibly well, living years longer than expected. The medical community calls them “super responders.” Statisticians might describe them as “outliers.” But they’re real people, alive because of Avastin.
R. Dov Linzer, Rosh Yeshiva of Yeshivat Chovevei Torah (YCT), in his speech at this year’s YCT semicha graduation, shared an idea related to last week’s Torah portion about the need to confront challenge head on instead of running away from it. I was directed to this speech through a post on Dr. Alan Brill’s blog (see here and the comments, which seem to be a sharp critique of the need for response and engagement). I have been turning over this speech in my head to see what is relevant and what is missing the boat. As such, let me share some points, both in response to R. Linzer as well as in response to some of the questions posed by Dr. Brill.
To begin, I find that R. Linzer is presenting a critique of the Orthodoxy of the centrist Orthodox/YU world, from which I myself was graduated (I realize that am lumping several smaller subgroups into this heading, but I am driving at certain points). As I read his words, the challenge he is placing before his rabbinic graduating class is how to find a balance between being innovative/creative and being pastoral. The balance I refer to is how to bring the Torah out of the desert without compromising on one’s role as a spiritual leader caring for others. How this is translated into reality is a different question. When I was beginning semicha at YU, we first year students had a dinner with R. Norman Lamm, who harped on the need for Rabbis to keep a structured learning seder every day, as well as the need to read multiple newspapers. While most of us can get our news from the internet in greater doses than a couple of papers, the other part, about a set learning schedule, is not nearly as simple. And it is this that R. Linzer is perhaps referring to. The rabbi must be a pastoral presence, but must also grapple with personal growth, both spiritually and intellectually. As an aside, this is a big challenge of chaplaincy, which some YCT’s graduates and students find themselves working in as well. Can one’s intellectual study find a place in one’s pastoral work? Is it even supposed to?
Now I will address some of the questions Dr. Brill presents:
According to the speech, there is a need to deal with Biblical criticism and the Holocaust. For the latter, you can tell everyone to read Kol Dodi Dofek, Yitz Greenberg, and Eliezer Berkovits but what are they expecting for Biblical criticism? Are they telling graduates to embrace it or just to spend an afternoon reading Mordechai Breuer? And if the goal is to open afresh: Why be Jewish? What answers do they expect?
He said “did we once again say that halakha will answer all religious questions?” Where are the new answers going to come from? How are they expecting the young graduates to grapple with these topics? Read Newsweek and blogs? Are these the topics that they should bring up with their congregations?
In terms of the issue of the relevance of grappling with the Holocaust, Zionism, biblical criticism, etc. I disagree with the idea that we no longer have to confront them, as many of the comments on Dr. Brill’s post want to argue for. I find that these topics have not become passe, as one can see in the blog world and within various Orthodox communities. In the community I live, a group got together about five years ago and established a lecture series under the title, The Orthodox Forum. What I find fascinating is that while much of the rhetoric is outdated or doesn’t respond to the challenges presented, there are many speakers on the circuit who feel that they can engage the topics with sophistication. As such, even for those of us who find the debates to be besides the point or irrelevant, people are interested and will always remain so. Just look at the titles of lectures being offered around the country, or the journals being published by Marc Angel’s Jewish Ideas and Ideals. Granted, it might be easy to argue that the topics this journal is covering are also in the category of irrelevant, but my point is that this is what people want, for otherwise the enterprise would not be as broad.
Personally, while I often struggle with the confluence of modernity and Judaism, I do believe that there are greater issues facing the Jewish community than Israel, the divinity of the Torah, etc., such as tuition, cost of living, economic and social change. We do have a responsibility to the world. I should clarify that I define this responsibility different from many. Nevertheless, to simply shrug off the grand questions as pointless is arbitrary and becomes a personal vendetta.
From a rabbinic standpoint, one must realize that when crisis hits, then of course, the questions and struggles disappear. And this is where the rabbi trained in pastoral care will thrive and potentially make a greater impact. Yet, in order to be effective at supporting people in crisis, one must first grapple with how crisis affects one’s own thought and life. Confronting ourselves in all our struggles will be the impetus to allow us to fight, to lead and to be confident in our authenticity.
I applaud R. Linzer’s effort to encompass the rabbinate in the metaphor of bringing the Torah out of the desert. It is a compelling way to look at life in the working world of the rabbinate.
Sometimes, when you are looking for inspiration, it finds you. In my email this morning was a link to the post linked below, about finding the right balance in life. Feeling at a crossroads, it was good timing.
Life appears easier when we are in the groove of our own pace and so very stressful when we are out of it. Being out of sync may not be the biggest problem in our life, but the discomfort it generates can often be avoided by checking in and taking corrective action when we get out of our groove.
Finally, when you notice that you are in your groove, going with the flow of life and enjoying your journey, pay attention to how you created that and do more and more of that. Turn on your cruise control and enjoy the ride.
When I was doing my CPE training, one of the most fascinating questions posed was, when did you get called. In many religious traditions, clergy often are those who claim to have a had a calling from G-d. This tends to be some form of event or conversation that triggers one to change one’s life and devote it to spreading the religion of which they are a part of. When I would try to explain that in the Orthodox Jewish world, the idea of calling is not something prevelant, the non-Jewish clergy would struggle to fully grasp that concept. Yet, I also go on to explain how I sense that my career in hospice chaplaincy was like a calling in the sense that all other avenues I thought of trying were turned off from me.
I recently found a quote which to me sums up my response to the question:
When Christian ministers aske me at what age or on what occasion I received my calling as a rabbi, I often find myself hesitating over how to respond. If I answer that it began when I entered yeshivah at age five to study Bible and Talmud, they might believe that I am likening myself to Jeremiah, who received his prophetic calling as a child. If I tell them that I have never received a calling but was ordained after my teachers concluded that I was intellectually capable of rendering competent decisions regarding what is prohibited and permitted by Jewish law, they might be shocked at meeting a modern version of a Pharisee. They could perhaps find confirmation for the allegation that legalism had replaced the living guidance of God. How could I, they might wonder preach the word of the Torah without first experiencing God’s direct active guidance in my life? How dare I assume responsiblity to mediate the living word of the God of Israel without being assured that I was called upon by God to undertake this sacred mission? Yet, as a traditional halakhic Jew, I know that a rabbi is a teacher whose spiritual role is premised on possession of an intelligent understanding of the Jewish tradition and a commitment to the Jewish people. A direct call from God is not required to legitmize activity as a rabbi in Israel. (David Hartman, A Living Covenant p. 5)
Death awareness, recognizing that death comes for everyone, is an area humanity struggles with, especially in this day and age. As the following post describes, those who have deeply ingrained spiritual practices will often have a more fundamental approach to the idea of death as a part of life. If we know we will die one day, then we might strive to live life more fully. The reality is that most people, even though death is not something hidden away, still find a way to deny the inevitable. Part of the reason for this denial is the basic human need to live. My soul, my ego, cannot fathom an existence that doesn’t include me in it. I have used this in practice, having challenged people to think about the concept of not being alive, and for most, the thought is something one has struggle to keep in one’s mind for more than a few seconds. Even those in health care, including hospice, while exposed to illness and death all the time, don’t always believe in his/her mortality, and thus lives life like it won’t end. I offer this piece a thought piece, with the title being the question to ask, because if we ask that question, then the other question, what do I want my life to have been about, will be a valuable tool to enhance our lives.
Many spiritual traditions advise that we keep the end in mind throughout life. But in this culture, contemplating death is seen as “heavy,” a downer. We’re less like Hamlet holding the skull of his family’s court jester, Yorick, and more like Scarlett O’Hara. We plan to think about death not today, but tomorrow or the next day. As a result, when the bell of mortality strikes, we’re totally unprepared.
“Shrinking away from death is something unhealthy and abnormal which robs the second half of life of its purpose,” said Marianne Williamson quoting Carl Jung. She was speaking at the recent Art of Dying conference jointly sponsored by the New York Open Center and Tibet House, and held at Menla Mountain Retreat Center. http://www.tibethouse.us with Williamson, and preeminent Buddhist scholar, Robert Thurman, Ph.D., who offered plenary talks and workshops, the conference featured a number of experienced leaders in spiritual hospice work.
Practitioners and healers who regularly bring presence, caring and spiritual contemplation to people in the transition between life-in-embodiment and death, see vital spiritual lessons for all of us in this inevitable passage. A recurring message throughout the three days, was that we are missing out on an precious opportunity for spiritual growth, when we avoid confronting and contemplating what we call death.
“Who do I need to be to be a trustworthy presence and compassionate person?” asked Frank Ostaseski. A co-founder of the Zen Hospice Project, the first Buddhist hospice in America, and founder of the Metta Institute‘s End-of-Life Care Practitioner Program. Ostaseski shared the inner contemplation that living daily with the dying had awakened in him.
Therese Schroeder-Sheker advises a daily practice of metanoia — contemplating and dying every day to the aspects of ourselves that don’t serve. Schroeder-Sheker has played the harp, and sung at the bedsides of those in transition for over three decades. She founded the palliative medical field of music — thanatology and the Chalice of Repose Project, which trains teachers in palliative music vigils with the dying.
A transparent joy exudes from those who attend the dying. Apparently, the active awareness of death can prompt us to live life with greater integrity, authenticity and purpose, knowing that our actions, thoughts and intentions count.
In our “materialist culture, people think that after death they go to the great Halliburton nothingness — and they are out of all consequences … ” said Robert Thurman, the author of “Why the Dalai Lama Matters.” He warned that “You are not getting out of the consequences of your actions by dying. Everything you do in life matters because it has an infinite resonance in the universe. [Facing up to death] gives us the power to be incredibly caring at even the tiniest level — it’s what guides our practical steps.”
When it comes to being with a loved one who is dying, Frank Ostaseski reminded participants that “We each have the capacity to embrace another’s suffering as our own. We’ve been doing it for thousands of years. You know how to do this — it’s in your bones.”
But he asked, “How did we turn this intimate act of caring for each other into an obligation, duty or profession? Dying is not a medical event — it’s about relationship with the self. We’ve forgotten this, and so we’ve become frightened. Too many people are dying in fear.”
The fear arises because “We see so much pain and suffering. We see genocides, holocausts and Hiroshimas,” says Robert Thurman, but he counsels, “They are real — but not really real. Bodies are incinerated — but souls are not.”
“On some level, we know that,” says Marianne Williamson, who pointed out that we sometimes turn away from death out of denial. Yet we also, on some level, know that the core of who we are does not die.
Fearfully avoiding the reality of death increases suffering at the approach of this inevitable life passage. And, paradoxically, so does the belief that we are nothing but a body.
“We’re born and we die,” Ostaseski noted, inviting us to “sit down with death and have a cup of tea.”
Williamson posed a question for that tete-a-tete:
“What would you do right now if you did not fear death?”