A few years ago, a poll came out showing that Americans were particularly frustrated because they spent too much time waiting at the Post Office to mail their packages. In response, the Postal Service directed 37,000 local post offices to remove clocks from public view, hoping that customers would be less conscious of how much time they were wasting in line!
Of course, hiding clocks can’t change the fact that they are still ticking. They don’t just tick while we wait. They tick – every second of the day – marking out the seasons of our lives, and ticking – ever closer – to our fated end.
We cannot help but acknowledge our mortality on this day, for we read the words of the Uneh Taneh Tokef over and over: “On Rosh HaShanah it is written, and on Yom Kippur it is sealed: How many shall pass on, how many shall come to be; who shall live and who shall die…”
Rabbi Jonathan Sacks writes of this text: “No prayer more powerfully defines the image of the Days of Awe […]. It is the equivalent in words to one of the great religious paintings by Michelangelo or Rembrandt. The language is simple, the imagery strong, the rhythms insistent and the drama intense.”
The holidays aside…I’m embarrassed to admit that until recently, I never gave much thought to my mortality.
But things changed after I moved to San Diego several years ago. As part of that transition, it seemed like the prudent thing to do to seek out an internist for an annual physical.
Keep in mind that according to a 2010 study of the federal Agency for Healthcare Research and Quality – only 57% of men (and a smaller percentage of young men and black and Hispanic men) have visited a doctor in the last year, as compared to 74% of women!
Despite the fact that my peers are largely avoiding doctors, I went for my first physical. As part of the routine visit, my doctor did a panel of blood tests.
Shortly thereafter, I was invited back for an unexpected follow up. My new doctor sat me down and explained that I was “prediabetic” – and was on the verge of having full blown Type II diabetes.
I breathed a small sigh of relief. There was no stage four cancer, or other imminent maladies. Nonetheless: I had gone into the office presuming that I was 100% healthy, and I exited with the knowledge that my future wellness was, if left untreated, at risk.
Type II diabetes, which I was officially diagnosed with in 2011, is not insignificant. Leading complications of the disease include an exponentially greater risk of heart disease and stroke, as well as high blood pressure, blindness, and kidney disease. Thankfully, I am blessed with excellent medical care, and the ability to manage my disease with diet, exercise, and a low dose of medication.
For me, the most frustrating part of my diagnosis was the question “Why”. I had always lived an active lifestyle…and while I have certainly enjoyed my share of junk food over the years, I have long-followed a mostly vegetarian diet that is heavy on things like tofu.
I learned soon after that diabetes, like so many other conditions, is not just about my lifestyle choices. It’s also about the particular set of genetics that I inherited.
We live at a time when an unprecedented amount of health and genetic information is being discovered everyday. And as we consider what it means to Jewishly accept and embrace our mortality, we might ask ourselves: What should we do with all of this data that is potentially at our disposal?
From the Jewish standpoint, WE ARE OBLIGATED to take full advantage of these new resources that are available to us.
This obligation grows out of the general Jewish principle that we should pursue wellness simply because it’s the right thing to do. Thus we read in Deuteronomy 4:9: “Take utmost care and watch yourselves scrupulously.”
But beyond this, our Tradition teaches us that we must use all the resources at our disposal to care for ourselves because of our fundamental belief that our bodies are on loan to us from God.
As Psalm 24 proclaims: “The earth is the Lord’s and all that it holds, the world and its inhabitants.” According to this theology, everything that exists in the world – including our bodies – was created by God, and on some level continues to belong to the Source of all Being. We are stewards of the bodies that were lent to us, and so we must take good care of them.
The medieval philosopher and doctor Maimonides offers us a third reason to embrace these new technologies. According to him, we are meant to acquire as much knowledge of the world was possible. Maimonides believed that the more we knew about the world, and about ourselves: the more we would come to know God. Thus he provides us with a theological and philosophical argument in favor of health and wellness. The more we know of our health and ourselves, the closer it will bring us to God.
There are three practical steps that we each might take in this new year, as we seek to make the most of the time that’s been given to us.
First: if you or someone you know is thinking about having children, then please spread the word: all prospective parents should be genetically tested to determine if they are a carrier of a Jewish genetic disease.
For those that are unfamiliar with Jewish genetic diseases: the Jewish Genetic Disease Consortium (JGDC) classifies 19 genetic diseases as associated with Ashkenazi or Eastern European Jewish background, and 17 with Sephardic or Mediterranean descent.
That is to say: Jews have an increased likelihood of being a carrier for the genetic diseases associated with their background, as compared to the average non-Jewish individual.
What does it mean to be a carrier? The majority of the Jewish genetic diseases are autosomal recessive conditions, meaning that if I inherit just one mutated gene associated with the disease – I carry it genetically, and could pass it on to future generations, but I can’t develop the disease myself. If both my parents were carriers, setting up the possibility that I had two mutations on the same gene, then there would be a 25% chance that I’d ultimately develop the disease.
The JGDC recommends testing for any individual who has one or more Jewish grandparents, regardless of the background of your significant other. Again: With these genetic diseases a baby is only at risk if both parents are the carrier of the same mutation. Therefore, some physicians suggest that only one member of the couple needs to get tested initially. The other would only need to be tested if the first tested positive as a carrier for any condition.
That was the advice that Amy and I got years ago when we first started thinking about having children. And so: I manned up for the big blood test first: enabling me to jokingly remind Amy about the “sacrifice” I’d made, every time she complained about the rigors of pregnancy later on….
Of course, Jewish genetic diseases are no laughing matter. Blooms, Canavan’s, Gauchers, and the rest are described by JGDC as “serious: fatal, life threatening or life-altering to the children born with them.” Genetic counselors are trained professionals who can work with prospective parents to make a decision that is right for them about how best to start a family after the results of their test have come in.
Beyond being tested for your carrier status regarding Jewish genetic diseases, there is a second approach to maximizing our wellness that is worthy of consideration.
23andMe is a new company that seeks to bring genetic testing to the masses.
23andMe situates itself at the center of a tradeoff: cheaper testing means less detailed genetic information.
Comprehensive genetic testing is called gene sequencing, where a geneticist will closely examine a particular part of your DNA to determine whether there are any mutations, which could lead to a disease.
23 and ME is not comprehensive gene sequencing. Instead, 23andMe identified a list of more than 240 health conditions and traits. For each of these, they only search the most common sites of a genetic mutation. To be clear: what 23and Me does is not comprehensive.
Nonetheless, there is value to their product. They make the world of genetic data easily accessible. And beyond the medical information they provide, there is an interesting social networking component that could connect you to distant relatives, if you are a fan of genealogy.
I am pleased to let you know that our Reform movement has entered into an informal partnership with 23andMe. Through this partnership, SSTTE has 100 free test kits that we’re able to distribute to any adult in the congregation that is interested. The kit, which normally costs $100, includes a spit test as well as a complimentary set of results. After you receive the results, you can choose to speak with a licensed genetic counselor for a fee, or bring the results to your doctor for further discussion. If you’re interested in a free kit, simply call the temple office.
I myself took the test several months ago, and was pleased with the experience I had. I found my interactions with 23andMe to be professional and straightforward. As for the results: I learned that – according to the testing that they did, I have an increased risk of developing prostate cancer, and that the blood thinner Plavix will probably not be maximally effective for me should I ever need it.
On the plus side, I learned that there are 293 people on 23andMe’s social network that are genetically-speaking, my 2nd or 3rd cousins, should I ever want to reach out to them. And I can confirm that my grandparents’ stories of our origins are true. Genetically speaking, I am 99.99 percent European.
23andMe was a positive experience for me. But I should clearly indicate that neither I, nor the synagogue, nor the Reform movement officially endorses all of this. There are serious issues which you and your family should consider before moving forward with an option like 23andMe. For example: how much are you comfortable learning about yourself?
After several months of careful reflection, I decided that if there was a technology out there that could tell me that I might be diagnosed with a medical condition in the future – then I would want to know about it, even if there was nothing that medicine could do to treat it. Based on some of the Jewish principles we discussed earlier, I realized that I wanted more knowledge about myself, so that I could be better equipped to navigate whatever my future might have in store for me.
You may feel differently. Obviously, your doctor and your family should be consulted, and I am always standing by to discuss this privately, if you need help determining whether this is right for you.
There are also privacy issues on the table. We are in relatively uncharted territory in terms of these companies and what it means for them to have access to our personal genetic information. There are federal and state laws on the books that prevent us from being discriminated against because of our genetics. Nonetheless, it is a new enough field that there may be value in being more cautious rather than less.
There is a third path to consider as we wrestle with our mortality.
We might begin our journey by spending time with our doctor or a genetic counselor. Sometimes a simple review of our family and medical history is the most sensible thing to do before deciding whether testing is appropriate for you.
As some of you may know, this is what actress Angelina Jolie recently did. She began by sharing her family history with trained professionals. Based on that history, they appropriately advised her to undergo comprehensive genetic sequencing on her BRCA 1 and BRCA2, the strands of genetic material that, if mutated, are most commonly responsible for breast and ovarian cancer.
Jolie’s test was positive for a mutation, indicating an 87% likelihood that she would develop breast cancer and 45% likelihood of developing ovarian cancer. As a result, Jolie chose to have a prophylactic double mastectomy. Removal of her breast tissue dramatically reduced her risk for both breast cancer and ovarian cancer.
Note that the genetic counselor I spoke with stressed that family history does not guarantee that you’ll have a disease like breast cancer. In fact, breast cancer is hereditary in only 5-10% of all cases. Speak to your doctor or genetic counselor, who can then counsel you on whether you should be tested further.
Over the last few months, my kids discovered the 1953 Disney film Peter Pan. You may recall that one of the iconic images from JM Barrie’s writing, and my son Avi’s favorite part of the movie, is the ticking clock, which is swallowed by, and remains in the belly of, the infamous crocodile. In the story, the “Tic Toc Croc,” who is obsessed with the idea of eating Captain Hook’s remaining good hand, is never able to stealthily encounter the captain: because the sound of the ticking clock always gives the croc’s presence away.
Captain Hook, then, perfectly embodies the struggle we confront today. We realize, if only on Yom Kippur, that we cannot deny the fact that we will some day die. Let us not run away in denial from the ticking clock of our eventual death. Instead, let us embrace our mortality by making the most of our lives every single day. And there is no better way to do that, than to take advantage of the astounding genetic technologies that are available to us, to make health decisions more proactively, if we only knew how to access them.
As Golda Meir once put it: “I must govern the clock – not be governed by it.” This is the challenge that lies before us, in the year ahead. Unlike Captain Hook, may we be courageous enough to meet it.
Keyn Yhi Ratzon – May this be God’s Will.
 Sacks, The Koren Rosh HaShanah Mahzor, pp. 564-565.