Presented at Keneseth Israel in Elkins Park, PA on 4/24/09 by Dr. Adele Schneider

This week there is a double parsha, Tazria and Metzorah which are read together every year except leap years in the Jewish calendar.

This parsha combination is not considered a popular one to discuss as the subjects are childbirth, circumcision and the laws of ritual impurity and purity. Tzaraat, (also described as leprosy) is a plague that requires the affected individual to be quarantined and to dwell outside the camp and away from others until he is healed. This is determined by the Kohen or priest, who pronounces the affliction as Tameh (impure) or tahor(pure) or cured. There are many different commentaries on these subjects. I will focus on Tzaraat and leave the childbirth descriptions to your own exploration and for you to draw your own conclusions about the difference in the treatment of the mother who gives birth to a male or female child.

Tazria discuses various forms of Tzaraat or skin maladies which are contracted as a result of engaging in forbidden gossip or lashon harah. Others consider Tzaraat to be a spiritual illness. Its identifying mark is a white patch or patches appearing on the skin of a person, on the walls of a home or on a cloth or leather garment.

As in all the debates in the Torah, the devil is in the details. Not every white patch indicates Tzaraat. In the human body, one of the signs of Tzaraat is if the white patch subsequently causes at least 2 hairs in its area to turn white. Now if the white patch precedes the white hair, it is impure. If the white hair preceded the white patch, it is pure. What if there is doubt?

One of the explanations that I found appealing comes from a Chassidic teaching that explains the human soul is driven by 2 contrary forces 1. the drive to run or escape RATZO (Ratz means run in Hebrew) 2. the drive to settle SHOV (shov means return)

Every time we are overcome by excitement, love, ambition or yearning we are running (RATZO) escaping the self to reach for something greater, more beautiful and perfect. Whenever we experience awe, humility, devotion or commitment, we are settling-(returning, SHOV) affirming our connection to our existence, our place in the world and our mission in life. RATZO drives us to climb a mountain, SHOV to build a home, RATZO to pray, SHOV to do a mitzvah.

In a spiritually healthy soul, the will vacillates between RATZO and SHOV like the rise and fall of a well balanced pendulum. The constraints of our place in the world, the finiteness of our nature and body, the boundaries of our very being, these impel us to escape them, to strive for the unbounded and the infinite. But our very escape brings us to a place from which we need to appreciate the beauty and necessity of our existence.

Thus RATZO peaks and provokes a counteraction of SHOV, a return to oneself and ones' place in the world.

Tzaraat is a condition in which this crucial balance is disrupted. This could be interpreted that the pendulum of the soul ascends in its RATZO arc but fails to swing back in SHOV-leaving behind a vacuum. This is symbolized by the white patches and the white hairs that are symptoms of Tzaraat.

The presence of the white hairs themselves do not indicate Tzaraat. These might represent the ordinary baggage of daily life, negative experiences that may have the positive function of challenging us and provoking our finest talents and most potent energies.

Before I add my own interpretation, we need to understand what happens in parshat Metzorah as well. In this parsha we learn, after a period of excommunication and penance, the leper (or a sinner) is welcomed back into the fold after offering a series of sacrifices to G-d in the temple. The cost of one's sacrifice varied according to one's financial position with liabilities of richer and poorer penitents being assessed on a sliding scale. Anyone could offer the sacrifice on behalf of another Jew. Offering to help another is a gift of love to one's brother helping him repent and reuniting him with his community. Volunteering to help a friend will not handicap you but will generate profound spiritual and material benefits.

I would like to suggest that the ignorance in the Jewish community about Jewish genetic diseases might be considered a form of Tzaraat. The Kohen or educators have the obligation to teach the community about Jewish genetic diseases. If Tzaraat disrupts the community balance, consider the effects on a family of having a sick child with one of the Jewish genetic disease and how the community should come forward to offer support on one side but take action to prevent this from happening again through education and screening all young adults.

Getting back to the Chassidic teaching of RATZO and SHOV, we strive to be happy in our lives. To have healthy children and to be spiritually content. If Tzaraat is present in our community, it disrupts the balance of RATZO and SHOV in our whole community and in any family affected by a JGD and as it is described in parshat Metzorah, we should be volunteering to help others in our community. How do we do this? It all comes back to the Jewish love of learning and our obligation to teach.

In the tradition of the Torah, physical well-being is inherently linked to spiritual balance. When a person is out of balance spiritually, the results could be a physical sickness which in the Torah might be the description of Tzaraat. The symbolic ritual process of healing described for the person with Tzaraat, with the help of the Kohen, attempts to fix the spiritual root of the problem.

Tikun Olam is an important basis of Judaism. To do this we need to re-focus on our priorities.

An important priority in the AJ community should be to educate all young adults of reproductive age about the risks of Jewish Genetic Diseases in their offspring. 1 in 5 Ashkenazi Jewish individuals is a carrier of a Jewish Genetic Disease like Tay-Sachs. There are 11 diseases that have a carrier rate higher than 1 in 100 in the Ashkenazi Jewish population and a simple blood test can detect whether or not you are a carrier.

Why is this important? A carrier is a healthy person whose only risk is to pass on a gene mutation for one of these diseases to his/her offspring. If 2 people are carriers of a mutation in the same disease-causing gene, they have a 1/4 or 25% chance with each pregnancy of having an affected child each time they get pregnant.

There are 2 ways to find out if you are a carrier. Have an affected child or get a simple blood test. It is a "no-brainer". Timing of the testing is important. If you know you are a carrier before you are pregnant, you have the largest number of options to have a healthy child of your own. Critically, carriers who know before pregnancy have the option of In Vitro Fertilization and preimplantation testing of the embryo with implantation of healthy embryos into the womb. Once pregnant, this option is not available. Then the options would include prenatal testing with an amniocentesis or CVS and the possibility of terminating an affected pregnancy.

Interestingly in Cyprus, where testing for a severe blood condition is now required by law they showed fewer abortions were done when people knew if they were carriers and had prenatal testing. Healthy pregnancies were continued with this knowledge. The previous practice had been to abort all pregnancies after that of the affected child because they did not want to risk having another affected child and the heartache of taking care of a sick child. So testing is really promoting more births of healthy kids. This was also the case when Tay-Sachs testing was introduced in the 1970's.

What are the diseases I am talking about? These are all autosomal recessive diseases in which parents are healthy carriers. The diseases are either fatal at an early age like Tay-Sachs (TS) and Canavan disease or they result in a life time of medical problems like Familial Dysautonomia, Bloom syndrome and Fanconi anemia. You all have heard of TS disease in which babies are born apparently healthy but then start to lose milestones around age 6 months and end up unresponsive with seizures, needing tube feedings and not really knowing the people around them. They usually die by age 5 years although better medical care is keeping these children alive a bit longer. Canavan disease and Niemann- Pick disease are similar to TS although I know of adults with Canavan disease. Longer survival does not mean improved outcome. Long surviving individuals with Canavan disease become unresponsive and make no developmental progress even if they live longer. They require total care irrespective of how long they survive. These are devastating diseases.

Tay-Sachs is well known because in the 1970's when they first discovered that you could identify carriers with accuracy and an inexpensive test (measuring the enzyme level, still the best test for TS), the community took up the challenge to educate and screen all young adults. With community participation this was a very successful program. Since carriers are healthy, in each generation we need to test to identify those at risk of passing on the gene mutations in these disease, even if fewer affected babies are being born. Since 1970 over 1 million Jewish people have been screened for Tay-Sachs. Our task now is a daunting one. To screen the whole community of adults of reproductive age for 11 diseases.

We, at the Victor centers, are trying to do this now but with more diseases the tests cost more. For now we are subsidizing much of the testing we do, but community buy in would help to make the testing available to more people as insurance does not cover the cost for many people who are not pregnant. So call your insurance to ask if they cover the testing if you are not pregnant and if they do not, let them know that this is illogical. If you know before you are pregnant that you are a carrier you can prevent the birth of sick children ...and sick kids cost the insurance company more.

Some of the diseases are not fatal in children and some individuals may live into adulthood with diseases like Bloom syndrome, Fanconi anemia and Familial Dysautonomia. But they are sick much of the time or have disabilities that make living difficult. The only condition for which there is good treatment is Gaucher disease where enzyme replacement can often reverse symptoms and offer a good quality of life in the long term for many with Gaucher disease. But at great cost.

The Victor Center brochures give you more information about the rest of the diseases, or check our website for more details. (www.victorcenters.org). The Victor Centers in Philly, Boston and Miami offer reduced rate screening in the community which includes genetic counseling to ensure informed consent. The importance of genetic counseling cannot be exaggerated. In talking with a genetic counselor, the individual will understand the implications of being a carrier and have the opportunity to discuss reproductive options if they are carriers and have all their questions answered. The Victor Center has its own genetic counselor who talks to all our patients. Also important to know is that if a Jewish person marries a non- Jew, he or she should still be screened as these diseases also occur in non-Jews although less frequently. So test the Jewish person first and if they are a carrier, test the non- Jewish partner. In addition the Victor Center offers outreach and education to all parts of the community as we are doing tonight.

The most important thing is to be educated and act on that knowledge to ensure that no more babies are born in our community with any of these PREVENTABLE diseases. While the incidence of these diseases has dropped significantly, there have recently been Jewish babies born on the East coast with Tay-Sachs and Familial Dysautonomia, preventable if parents had known they were carriers. So please join me in making sure that Tzaraat does not affect our community, that we become educated and prevent the birth of any children with these disease in our community.