The parapet

A good friend told me that my posting on dangers of Tylenol didn't seem to fit in with what this blog is all about.

That, of course, raises the important question of just what this blog is about. When I started it , I said that I expected the exact shape of it to arise as a work in progress as it went on. Clearly, Torah (along with chaplaincy and chaplaincy education) has become a central concern of the blog as it has developed over (just the) last few weeks. That reminds me of what one of my teachers in rabbinical school , Rabbi Ed Feinstein, taught us: everything that comes out of your mouth [or into a blog!!] as a rabbi is rabbinic speech. And you thus need to judge everything you say to others by the standards of rabbinic speech.

What then is rabbinic speech? Well, one of Rabbi Feinstein's requirements is that it "has a text." Specifically, a Holy text from the Jewish tradition.

Now, I have to admit that hardly everything that comes out of my mouth has a holy text in it!! . . . But Rabbi's Feintein's point has much validity. I probably need to consider everything I post on this blog to be rabbinic speech. And that, therefore, everything should have a text -- or some other kind of Torah -- associated with it.

So, I think my friend was very right. The Tylenol posting didn't fit on this blog. Not that the subject didn't fit -- in the spirit of אף עד כאן , I would say that a concern about something that causes people hurt and pain (a concern raised by my Tylenol post, for example) certainly is Torah and belongs on this blog. But there needs to be something that marks it more specifically as Torah.

So, the most obvious text that fits with my concern about Tylenol is definitely the parapet (Deut. 22:8):

כִּי תִבְנֶה בַּיִת חָדָשׁ, וְעָשִׂיתָ מַעֲקֶה לְגַגֶּךָ; וְלֹא-תָשִׂים דָּמִים בְּבֵיתֶךָ, כִּי-יִפֹּל הַנֹּפֵל מִמֶּנּוּ.

When you build a new house, you shall make a parapet for your roof. So that you will not bring down blood upon your house when someone fell from it.

A parapet is a low wall that would keep someone from falling from the roof.

I need to take a little aside here to say something about the nature of Judaism . . . and why I love it so much. And how it is truly fundamentally different than (our sibling faith) Christianity. . . . . because this very text is just the kind of text that Christianty turned its back on (when it made it's New Testament, or new covenant/ברית with God) . . . and it's just the kind of text that makes me love my faith tradition so much. . . It's just the kind of text that is in the spirit of the words of Rabbi Akiva's students -- even this far? Even this far, our master? Does Torah -- and its daily and sometimes mundane laws and commandments -- extend even this far?

The answer, both I and Akiva say, is "yes". Yes, even this far . Torah goes everywhere. Even into how you build your roof. We Jews have kept the law. We are proud to remain a faith of law and not one that is belief and love-centered like Christianity is. Like (our other sibling faith) Islam, we value law and obedience as well. Proudly.

The parapet verse comes from one of the weekly Torah readings -- parshat Ki Teitzei (Deut. 21:10-25:19). While Christians seem to hold that the 10 Commandments is the main lawgiving in the bible, we Jews stick with the much more detailed lawgivings of this parsha and the one other great lawgiving in the Torah -- and the one that comes _after_ the 10 Commandments -- parshat Mishpatim (Ex. 21:1-24:18).

These two parshas contain laws on some of the most mundane things, especially about business dealings. Chapter 22 -- in which our verse is found -- starts out with the seemingly mundane commands to return to your fellow things that they have lost and even to go out of your way to go after their livestock should you see them wandering away.

American law -- with its obsession with individual rights -- almost never requires one to go out of one's way to prevent another's economic loss; if you see someone's barn burning down, you have zero obligation under American law to even call the fire department.

We Americans, however, do seem to be slowly, yet surely, starting to see the wisdom of an obligation to go out of one's way to prevent another's physical injury as Jewish law has since the time of our verse about the parapet. Our ancestors knew that we had to be required to do things to prevent physical injury -- the spilling of blood -- of others. Thus, the requirement to build the parapet.

We in America, however, don't seem to have fully understood this ancient wisdom. We are still -- again with our obsession with individual rights -- reluctant to legally require anything of anybody. We prefer to use the threat of lawsuits to encourage people to take steps to prevent physical injury on their property. It's an ugly and expensive system that fails to distribute justice equally. Some injured people receive nothing to compensate them, while others receive windfall amounts. Some property owners are influenced by this to create adequate safety conditions on their property. Others do nothing. Nobody wins.

One of those property owners who do not seem to see the wisdom of the ancients are the manufacturers of Tylenol. They have a drug that needs a parapet. It's not that Tylenol should be taken off the market -- anymore than people should be banned from building roofs. It's that it's too easy with Tylenol for someone to slip off and accidentally injure -- or kill -- themselves. The articles I cited show that between 20 and 25% of all liver failure cases in America are from accidental overdoses of Tylenol. Accidental.

This is a drug that hardly anyone is aware is dangerous at all. People think it's as safe as aspirin. It's not. It's incredibly easy to accidentally overdose. The manufacturers of Tylenol need to finally admit that and -- in partnership with government -- come up with a way of preventing these deaths.

The Torah says they have to.

More dangerous than metal fragments

יום שישי י''ט בחשון תשס''ז

Tylenol (or, more accurately, acetaminophen, which is the generic name for the drug most commonly known as Tylenol) is back in the news.

The AP reports that a massive recall is underway because of possible metal fragments in pills sold under store brands by Wal-Mart, CVS, Safeway and many other major retailers.

No deaths or injuries have been reported (at least not yet) due to this contaminant. But you can't say the same about what's supposed to be in the pills -- acetaminophen, itself. The dirty little secret about acetaminophen is that thousands of people are injured or killed every year from accidentally overdosing on this over-the-counter medicine that can be found in everything from cough syrup to prescription pain killers (anything, like Percocet, that has -cet at the end, has acetaminophen in it).

The problem with acetaminophen is that, unlike aspirin for example, the amount that can seriously harm you is not all that much greater than the recommended dosage. This article says that 42% of the new cases at liver centers are due to acetaminophen overdoses. About half those cases were accidental overdoses, not suicide attempts.

Here is the conclusion of an academic article cited on the wikipedia acetaminophen article:

[Acetaminophen] is a commonly used, moderately effective analgesic and antipyretic. In overdose it causes significant morbidity and mortality. The burden to health care services is considerable, with a high financial cost and many hospital admissions. According to the Medicines Control Agency Medicines Act Leaflet (MAL 82, March 1996), which gives guidance on changing the legal classification of a medicine to the General Sale List, a criterion for inclusion on the General Sale List is: ‘where the hazard to health, the risk of misuse, ... is small and where wider sale would be a convenience to the purchaser’. It is surprising that [acetaminophen] is available on the General Sale List, as it appears to fail this criterion for an OTC medication. [Emphasis mine]

Bottom line -- there is very real public health threat here, and something needs to be done. I hope the metal fragments stories will raise people's consciousness about the real risks of this medicine.