Volume 29 Number 38
                 Produced: Wed Aug  4  7:08:11 US/Eastern 1999

Subjects Discussed In This Issue: 

Cancer in Israel and Operation Refuah (2)
         [Carl and Adina Sherer, Robert Israel]
On previous generations
         [Shmuel Himelstein]
Operation Refuah (2)
         [Joel Rich, Hadassa Goldsmith]


From: Carl and Adina Sherer <sherer@...>
Date: Fri, 30 Jul 1999 17:56:08 +0300
Subject: Cancer in Israel and Operation Refuah

Eliyahu Shiffman writes:

> I am happy to report that I have it on good authority that Carl Sherer's
> info on the incidence of cancer in Israel is quite incorrect.
> Carl wrote:
> > The incidence of
> > childhood brain tumors in Eretz Yisrael is more than double the
> > rate in the United States, and the incidence of breast cancer in
> > middle-aged women here is somewhere between one in four and
> > one in three, which is also a much higher rate than in the United
> > States. <snip> the fact
> > remains that at least in Eretz Yisrael there is a higher percentage
> > of people suffering from these diseases than before and elsewhere.
> I asked oncologist Prof. Raffi Catan of Shaare Zedek Medical Center in
> Jerusalem how Israel's rate of childhood brain tumors compares to that
> of the US. His answer: "more or less the same." I asked him how Israel's
> rate of breast cancer, particularly in the case of middle-aged women,
> compares to that of the US. Again, his answer was "more or less the
> same."

Eliyahu and I have been going back and forth about this off list all
week. I'd like to summarize some of my responses to this without bogging
you down with a lot of numbers.

On children's brain tumors, my source was Dr. Michael Cohen, a
Neurologist at SUNY-Buffalo and probably one of the world's foremost
statisticians when it comes to childhood brain tumors.  While the word
"double" may have been a guzma (exaggeration), he told us unequivocably
that the rate of childhood brain tumors is much higher in Israel than it
is in the United States. Three possible reasons for the discrepancy
between what I was told and what Eliyahu was told are:

First, in the States ALL brain tumors are classified as cancer and are
tracked, whereas in Israel, only "malignant" brain tumors R"L are
classified as cancer and show up in the statistics. Therefore, the
official statistics in Israel might not reflect the actual incidence of
brain tumors. If anything, Israel is probably under-estimating the
incidence of brain tumors, and that's why a doctor could look at the two
numbers and see a lower number in Israel.

Another thing that you have to keep in mind is that the most recent
statistics that are publicly available are 4-8 years old. Dr. Cohen was
basing himself on the number of surgeries Neurosurgeons in Israel told
him they are performing TODAY as compared with what he knows to be the
situation in the US.

Third, Eliyahu asked an oncologist. Oncologists do not see many of the
brain tumor patients. Often, if the tumor is benign, surgery may be the
only intervention required. By the way, what kind of oncologist is
Professor Katan? Most of the oncologists we have come into contact with
have a subspecialty these days....

Brain tumors now have the highest incidence of newly diagnosed childhood
cancers, having taken over for leukemia (which has a higher cure rate).

As to breast cancer, my original source for that was a bit less
reliable. However, I have since gotten onto the Israeli Ministry of
Health's web site (http://www.health.gov.il/icr/HTML_95/icd174_1_1.html)
which R"L showed an increase of 9% in the incidence of breast cancer in
Jewish women in Israel aged 45-59 between 1990 and 1995.

He said that in general the incidence of
> cancer has stayed stable over the last 70 years, with the significant
> exception of lung cancer, the rate of which has risen dramatically
> during that period.

I personally find that very difficult to believe. Just to a few
examples. According to the World Health Organization
http://www-dep.iarc.fr/cgi-bin/cgisql/who2.idc, the mortality rate for
women's breast cancer in the US was 24.7 per 100,000 in 1950. It broke
30 for the first time in 1977 (30.5) and was over 30 every year from
1977-96 except 1979. In Israel,
http://www-dep.iarc.fr/cgi-bin/cgisql/who2.idc, the rate for Jews was
only 12.7 per 100,000 in 1950. The rate in Israel broke 20 for the first
time in 1960, and except for 1961 it was over 20 every year from 1960-76
(the last year for which there are data available on the WHO site). The
rate for 1976 was 29.2 fairly close to the American rate. You can decide
which rate is going up more quickly, and whether the rate of cancer has
increased in the last 70 years. And that's the MORTALITY rate, which
means there were more than twice as many people dying in Israel from
breast cancer in 1976 as there were in 1950.

1990 estimates of incidence (adjusted for age) show the US in second
place worldwide at 87.09 per 100,000, while Israel was in 15th place at
72.21 per 100,000 (ahead of both the UK and Australia). Anyone want to
bet on what has happened in the last decade?


Moshe Feldman writes:

> I don't want to sound insensitive.  Clearly, we should provide both 
> spiritual and physical help for those who suffer from the diseases that 
> Carl mentioned.  Nevertheless, I question whether, when *all* diseases are 
> examined, whether it is correct to state, "It is no secret that every 
> Jewish community around the world is being hit with terrible tragedies."  
> Are people dying earlier now than they did 30 years ago?  

That's not the point. Thirty years ago, did every school have at least
one child on chemotherapy or dying of cancer? Did every school have at
least one family of orphans? In my entire elementary and high school
career, I recall one child dying R"L (he was hit by a car) and two
families being orphaned. Adina recalls one family being orphaned in her
entire time in school. Yet today, teachers are routinely told that
before they give a class an assignment to ask one parent or the other
something, they should first make sure that all the children in the
class have both parents!  Every neighborhood we know has at least one
family where someone is seriously ill. In our shul, one of many in this
neighborhood, aside from Baruch Yosef, I know of one child who died of
cancer and of an adult (in his thirties) who is a leukemia survivor in
the last year.

> My point is: before OR makes these statements, it should do some sort of 
> statistical study.  Until it does, I will stick with my guess that with the 
> advent of e-mail and the web, we are able, more than ever before, to hear 
> about many Jews all over the world who are, rachmana litzlan, suffering 
> from illness.  But I doubt that, percentagewise, there are *more* people 
> suffering. 

I think there really is more incidence, but that we also hear about it
more because of the net. My impression is that there are more young
people suffering. One of the big problems with this field is the age of
the statistics. Go walk around some of the oncology wards and ask what
their workload is like compared to even five years ago....

Yehuda Poch writes:

> In the first 3-4 years of the list's operation, the listing grew from an
> initial 10 names on the list to around 100 in a busy month.  Today there
> are in excess of 300 names on the list each and every month, sometimes
> in excess of 400.  

I think it's important to point out that you throw out all the names
once a month.

-- Carl M. Sherer

Please daven and learn for a Refuah Shleima for our son,
Baruch Yosef ben Adina Batya among the sick of Israel.  
Thank you very much.

From: Robert Israel <israel@...>
Date: Sun, 1 Aug 1999 13:38:33 -0700 (PDT)
Subject: Re: Cancer in Israel and Operation Refuah

To expand on Moshe Feldman's point:

According to the Central Bureau of Statistics 

  According to figures published on 6 August by the Central Bureau of 
  Statistics, half of Israeli girls born between 1991 and 1995
  can expect to reach the age of 81, and half of Israeli boys born during 
  this period can expect to reach the age of 78.

  In 1995, Israeli women were expected to live an average of 79.5 years and 
  Israeli men were expected to live an average of 75.5
  years. Jews were expected to live slightly longer than Arabs, with Jewish 
  women forecast to live 79.8 years and Jewish men
  some 75.9 years. 

  In comparison with men in other countries, Israeli men have the third 
  highest life expectancy rate in the world. Japanese men
  were expected to live longest at 76.5 years and Swedish men came in 
  second at 75.5 years.

  In 1993, American men were expected to live 72.2 years. The 79.1 year 
  life span of Israeli women in 1993, however, ranked 17th
  in the world. Japanese women were expected to live longest and reach 83.1 
  years, followed closely by Swedish women, who
  were expected to live 82.3 years. 

So it appears that, at least as far as life expectancy is concerned,
Israelis are doing very well.  Moreover, life expectancies have certainly
improved over the years.

As for cancer, according to the WHO Databank 
in 1994 Israel's age-standardized rate of mortality from all cancers was 
129.2 per 100000 for males and 104.3 for females, while the US had 160.6 
for males and 109.9 for females.  Again, especially for males, Israel is 
doing very well.  

Of course I don't want to sound insensitive - a lot of people are 
suffering.  But to suggest that the amount of this suffering 
has increased, or that there is proportionately more of it among 
Israelis than in the other populations, is simply incorrect.   

Robert Israel                                <israel@...>
Department of Mathematics        http://www.math.ubc.ca/~israel 
University of British Columbia            
Vancouver, BC, Canada V6T 1Z2


From: Shmuel Himelstein <shmuelh@...>
Date: Sun, 1 Aug 1999 14:40:02 +0300 
Subject: On previous generations

Carl Sherer explains that the previous generations of American Jews were
not as learned, and hence carried out certain actions which were
contrary to Halachah. As opposed to this, most Frum Jews 50 years old or
younger received a Frum education.

While this might well be a true and logical differentiation, it does not
explain the fact that the wives of certain great Roshei Yeshiva (where
both husband and wife were born and educated in Europe) did not, in the
1930's and into the 1940's, cover their hair, and only began (or resume)
doing so at a later time.. And that was certainly not a question of lack
of education.

Shmuel Himelstein


From: Joel Rich <Joelirich@...>
Date: Fri, 30 Jul 1999 08:26:37 EDT
Subject: Re: Operation Refuah

 I fully support the efforts of Operation Refuah, and I publicize their
 activities through the cholim list.  There is no question in my mind,
 internet and greater publicity notwithstanding, that there has been an
 increase in the level of tragedy the Jewish nation as a whole has been
 suffering the past 18 months or so.  >>

 I agree that doing more mitzvot for just about any reason is a good
thing. I would have no problem with a statement such as "in my(our)
estimation/anecdotal experience... there has been an increase in
suffering which requires soul searching...
 As a practicing(till I get it right) actuary and daati Jew, I disagree
with making unsupported generalizations.You lose credibility if your
"perception" is later disproven . You also lose some of it up front when
someone looks at your "claims" and feels there's no credible evidence
behind them.
 Kol Tuv,
Joel Rich

From: Hadassa Goldsmith <hbgold@...>
Date: Fri, 30 Jul 1999 17:15:20 -0500 (CDT)
Subject: Operation Refuah

In response to the recent postings on Operation Refuah, I think we can
all agree that whether one does or does not believe that the number of
cholim is increasing it behooves us to do whatever possible to try to
bring refuah to the ill and blessings to all of Klal Yisrael.

In a recent newsletter put out by a leading organization that assists
families with ill children, a woman comments on a shabbos spent together
with other families with ill children: "...how the barriers all came
down here - how Jews from every background came together and related to
one another simply as people concerned about the well-being of each
other's children. It was just amazing to me, sitting in the dining room
on Shabbos, seeing the men dancing around the tables wearing shtreimels
and black hats and knitted yarmulkas - even no yarmulkas at all - and
knowing they all cared about one another from the depths of their

Yes, it is true that illness and other tragic situations always bring
home the point that we are all one family, despite our differences. Now
let us all work together to show Hashem that we are ready and able to
act toward each other - under "every day" circumstances - like one
family, with Ahavas Yisrael toward each Jew we meet, those who are like
us and those who are not.

If you would like to join with other Jews who are rededicating
themselves to the mitzvah of V'Ahavta L'Reyacha Kamocha - Love your
neighbor as yourself, please e-mail us at <OREFUAH@...> and check out
our website at www.sjrassociates.com/orefuah.html

Hadassa Goldsmith
Operation Refuah


End of Volume 29 Issue 38