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Cervical cancer vaccine. (VOA)

Preventing Cervical Cancer.
Pekuach Nefesh (Saving Life) at Bat Mitzvah Time.

-- Rabbi Phyllis O. Berman 
-- Rabbi Arthur O. Waskow

A federal vaccine advisory panel, the Advisory Committee on Immunization Practices at the Centers for Disease Control and Prevention, voted unanimously on June 29 to recommend that all girls and women ages 11 to 26 receive a new vaccine that prevents most cases of cervical cancer. 

The vaccine is known as Gardasil. It protects against cancer and genital warts by preventing infection from four strains of the human papillomavirus, the most common sexually transmitted disease.

Gardasil should be available now.

Celebrations of becoming bat mitzvah happen typically at age 12 or 13. We urge that synagogues require that bat mitzvah preparation include a focused discussion and decision by the girl and her family whether to be vaccinated against the Papilloma virus, as part of a broader discussion of many sexual issues. 

The virus is sexually transmitted. So -- although cervical cancer is limited, of course, to women -- males pass on the virus and do suffer from genital warts and, rarely, penile cancer. It is distressing that the vaccine has not yet been formally tested on males; but most medical authorities think it is likely to make sense to vaccinate boys as well. When that is determined to be safe (or now, if family physicians think it responsible), boys should also be required to take part in a focused discussion and decision, as part of their bar-mitzvah preparation. 

Taking these steps would mean that as an act of pekuach nefesh -- saving life, the highest commandment of all in Jewish teaching -- our synagogues and families consciously and explicitly recognize the onset of sexual maturity around this age. Some might argue that in order to safeguard life, the vaccination should be required. We recommend that the discussion be required, and as part of the onset of mature responsibility, the child entering puberty should be free to choose whether to be vaccinated. 

As we have consulted various people about this proposal, some concerns have been raised:

  1. That (although there is little or no evidence that particular vaccines cause health problems anything like as great as the problems caused by the disease they are aimed at) the proliferation of vaccines for various diseases may be creating health problems not yet understood; 
  2. That Merck, the sole producer of Gardasil, has a very mixed track record of honesty in carrying out and reporting the safety tests on various other medicines, and the federal government has a mixed track record in using enough care to oversee and assess corporate reports on safety.

For these reasons among others, we think family doctors and pediatricians should be involved in discussions that twelve-year-olds and their parents might have about vaccination, and the decision should be left to the adolescents and their families. But we do believe synagogues should insist there be a serious discussion, and should set as a context the broader discussion of sexual issues with all candidates for bar or bat mitzvah celebration. 

Is raising the issues of sexuality a stark departure from Jewish tradition about the meaning of bar / bat mitzvah? Hardly! The Talmud, assessing when it is that a boy becomes responsible to carry out the mitzvot (thus "bar mitzvah," "child of commandment" or "participant in the commandment process"), says first that it is upon the appearance of two pubic hairs. Then it acknowledges discomfort at the idea of checking each boy individually to see when this happens, and ends up naming the age of 13 years and one day to apply to everyone. 

The celebration of bat-mitzvah ceremonies for girls like those of boys is a fairly recent innovation. But Jewish tradition saw 12 or 12-and-a-half as times when girls might be espoused or married and no longer live under their fathers' authority. Again, the sexual element was explicit. 

It has only been in more recent centuries that Jews have taken on some prudish notions that becloud the truth of asserting, "Today I am a man," or "a woman." Those statements are no longer true for 12- or 13-year-olds about marriage, or full-time jobs, or completed educations, or mobility in automobiles instead of horses, or taking part in elections -- but they remain biologically accurate. 

Commitment to encouraging papilloma vaccination should not be limited to the bar / bat mitzvah class. Gardasil will cost $360 for its three-shot regimen. On the basis of the Federal recommendation, health insurance companies will probably reimburse part of this cost for girls. They may not, for boys. Synagogues should make sure that families of their own for whom the $360 is a difficult hurdle get communal help to meet it. And synagogues, led by their social-action committees and their rabbis, could be lobbying federal and state agencies to make sure every child who wishes can be vaccinated. 

Already, in the last few years, moved in part by reports of intense sexualization of the conventional Saturday-night bar/ bat mitzvah party, some synagogues have begun requiring sex education for their 12-year-olds. The advent of Papilloma vaccination strengthens the reasons for requiring sex education at this age.

Would taking these steps mean that our synagogues and families affirm that sexual intercourse at 12 or 13 is physically, emotionally, or spiritually desirable? No. But it does mean taking note that some studies show the average age of first intercourse for American girls is 15. It does mean that every synagogue's course of study toward bar / bat mitzvah celebration should include not only learning about the sexual "plumbing" -- how our bodies operate sexually, both for joy and in danger -- but also sexual ethics and the role of sexuality in spirituality. 

And above all, it does mean deciding that the lives and health of our children are more sacred than taboos about discussing sex. 

Rabbis Berman and Waskow are co-authors of A Time for Every Purpose Under Heaven: The Jewish Life-Spiral as a Spiritual Journey, and Rabbi Waskow is the author of Down-to-Earth Judaism: Food, Money, Sex, and the Rest of Life and the director of The Shalom Center

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Raising A Mensch Section Editor: Dr. Flaura Koplin Winston parenting @ pjvoice.com
Dr. Flaura Koplin Winston is a practicing pediatrician, professor of pediatrics and Scientific Director of the Center for Injury Research and Prevention at the Children's Hospital of Philadelphia. She welcomes your comments, questions, contributions and suggestions for future columns.