Dr. Deena Zimmerman is an equally appropriate author for “Midor l’Dor – Genetics and Genetic Diseases: Jewish Legal and Ethical Perspectives.” The Hebrew words mean “from generation to generation.”
She earned her BA at Yale and MD at Albert Einstein College of Medicine. In the program of advanced Torah study for Women at Nishmat in Jerusalem, she earned the title yo’etzet halacha, female halachic advisor who answers women’s questions about the mitzvah of family purity. She wrote A Lifetime Companion to the Laws of Jewish Family Life (2005), a clear halachic and scientific presentation of the mitzvah. In Israel she works at TEREM Emergency Medical Services. She and her husband are the parents of three boys and two girls.
Dr. Zimmerman begins with an organized, cogent, short course in genetics so that a layperson can understand what the field is about. It’s helpful to study this opening section; when she notes in a later chapter that a disease is “inherited in an autosomal recessive manner,” you will understand. The mother and the father each carried a recessive gene for the illness and were unaware that there was a 25 percent chance that their baby would have the disease. It is understandable that they are shocked.
When you learn that many genetic problems are the result of carriers marrying each other, and see in which areas of Jewish settlement – Lithuania or Morocco, for example – there is a greater likelihood of being a carrier of a problematic gene (say 1:10 instead of 1:500), you have a good argument for marrying a spouse with an ancestry different from your own.
The section on “Genetic Diseases with a Jewish Association” is sobering. There are thirty-six titles here, and five more diseases that Jews may suffer from at the same rate as the rest of the population. For each one, Dr. Zimmerman gives a summary of the nature of the illness, the historical background, diagnosis of the condition, sources of information, suggested reading, and support organizations with addresses and phone numbers. She has done all the work.
She advises parents to consider that each child is unique. The information she gives “for general consumption may not include all the variations that can be found in individuals.”
She recommends asking questions and speaking up. “The health care professionals may have more experience with the condition, but you have more experience with your child.” She is frank about how knowledge of genetics keeps growing, and mentions that one chapter “will soon be out of date.”
There are fascinating facts throughout the book. For example, Jews of Lithuanian ancestry have a high carrier rate of a gene that leads to elevated cholesterol from birth. She adds the interesting observation that “a preponderance of the mutation” is found in South Africa, where many Litvaks emigrated.
I was surprised to learn that “screening tests are designed in such a way that a certain amount of false positives and false negatives are tolerated.” A test that has a 90 percent rate of actual cases and 5 percent rate of false positives is acceptable. I now understand why she writes that a screening test does not provide a diagnosis.
She explains that Dor Yesharim now tests for a number of diseases in addition to Tay-Sachs and reports on a study in the haredi community in Israel between 1986 and 1992 that found no children were born with Tay-Sachs after the testing started. (A young doctor told me that the approach of Dor Yesharim is now taught in medical schools across the country as the way to prevent a genetic disease within a certain population.)
Dr. Zimmerman’s footnotes juxtapose quotations from the Talmud and scientific reports. After discussing so many diseases and making us wonder whether our lives are predetermined by our genes, Dr. Zimmerman, like Dr. Debow, closes with an insightful Torah lesson that asserts the power of free will.
This review first appeared in an article called Utilizing Halacha To Address Difficult Social and Medical Issues in the Jewish Press.