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Sunday, September 09, 2012

A Bracha on Medicine

If a medicine is not palatable, it is not a food.  If it is not a food, you don't use the brachos that are for food when you take it.  If the medicine is palatable, it is a food, and you make a bracha on it (although that bracha might be she'hakol; see OC 204:8 and Aruch Hashulchan 204:22.  Also, See Rabbi Bodner's ותן ברכה chapter 13:15.1, quoting RS'Z Auerbach's solitary opinion that if you would not eat it as a food, then you do not make a bracha even if it has a good taste.)  That is not what this post is about.  I want to discuss the bracha one would make for the therapeutic quality of the medicine.

Based on the Gemara in Brachos 60a, the Mechaber (OC 230:4) says that when one begins a blood letting, a process once thought to be salubrious, one should say  יהי רצון מלפניך ה'  אלוקי שיהיה עסק זה לי לרפואה כי רופא חנם אתה.  After the process is finished he should say בָּרוּךְ רוֹפֵא חוֹלִים.  The Mishna Berura (SK 6) and the Aruch Hashulchan (5) say that this applies to all medical procedures, and whenever one takes a medicine or engages in a medical procedure he should say these words with Hashem's name.  (We are not noheg to use Hashem's name in the bracha after the procedure, but we certainly ought to say יהי רצון מלפניך ה'  אלוקי, considering we are going to say that when we eat the simanim Rosh Hashannah night.  Taking medicine is far far more serious.)

During my shiur, one of the talmidim asked a good question.  The Gemara in Brachos 35a says that Chazal instituted formal brachos on foods because of the compelling logic that we ought to thank Hashem when we benefit from His world. סברא הוא אסור לו לאדם שיהנה מן העולם הזה בלא ברכה -it would be a sin to benefit from Hashem's world without blessing Him. If so, why shouldn't we make a bracha when we take medicine?  Are we not benefiting from Hashem's world?  Are we not grateful that the medicine cures us or alleviates our pain?  It would seem that the logic that instructs us to express our gratitude for the nourishment we get from food would compel us to make a bracha on the therapeutic benefit we get from a medicine.  

One might propose an answer that the bracha on food is primarily for the pleasure we have from eating, not for the nutrition of the foods.  If so, we would only make a bracha on medicine if we enjoy the administration of the medicine.  I disagree.  (Please note that this is indeed a machlokes Achronim insofar as what Birkas Hamazon is on, the enjoyment or the nutrition.  In fact, this was the topic of my Bar Mitzva Drasha in 1965.  But I do not believe that the logic of the din derabanan of bracha rishona is necessarily the same as the logic of the din deoraysa of bracha achrona.)  While it's true that we make a bracha only on palatable foods, not on nutrients that we don't enjoy ingesting, or on intravenous nutrition, the primary purpose of the bracha is to express our gratitude and acknowledgment to Hashem for sustaining us.  It's like the mitzva of Sukkah:  we are chayav to live there, but Chazal were kovei'a the bracha on eating because when you eat you focus your attention on the enjoyment and circumstances of your meal.  If we didn't eat in a Sukkah, Chazal would have been kovei'a a bracha on sleeping, or reading the newspaper, or sitting and shmuzing in the Sukkah.    Since we do eat there, they chose eating as the best moment to make the bracha.  But the ikkar is the Taduru, and here the ikkar is the nutrition.  Since by medicine you never enjoy taking it, Chazal should have been kovei'a a bracha on all medicines.

The Magen Avraham (OC 216 SK 1) brings that one only makes a bracha on palpable physical enjoyment, and this is why we don't make a bracha upon hearing a beautiful voice, or a massage, or the heat of a fire.  That is all fine, but it doesn't explain why we wouldn't make a bracha when we take a medicine.  It's palpable and it directly affects the body exactly like food.

The answer to his question is that while both food and medicine are beneficial, there is a fundamental difference between them:  Food nourishes us and contributes to the body's regeneration and growth.  Medicine is 
מבריח ארי, it eliminates a problem.  Medicine eliminates an infection, is cures a malady, it alleviates pain.  It is, in a sense, Rashi's מלאכה שאינה צריכה לגופה, something that you have to do to remove a problem, not something that you do because you want a positive benefit.  The Svara of Bracha applies to enjoyment/benefit that is absolute, not the enjoyment/benefit you have when something stops hurting you.  (see, e.g., Rama in OC 204:8, but see also the Mechaber in 204:9, and how the Aruch Hashulchan resolves them in 204:19.  This is not an exact match: it is just a tzushtell.  Look inside and you'll see what I mean.)

Although we certainly do make brachos on being saved from mortal danger, namely  הטוב והמטיב and שעשה לי נס במקום הזה, those are brachos of שבח והודאה, not ברכת הנהנין.  The logic of ברכת הנהנין is totally different than the logic of ברכות שבח והודאה.  A proof of this distinction is the shitta of Rav Yehuda in the Mishna on 40b who says that we don't make any bracha on a food that comes from a klala, such as locusts: כל שהוא מין קללה אין מברכין עליו.  Does Rav Yehuda disagree with the brachos of הטוב והמטיב and  שעשה לי נס?  No, he does not.  It must be, then, that the logic of ברכת הנהנין is different than the logic of ברכות שבח והודאה.

Someone then pointed out that this would only explain why we don't make a bracha on the most common medicines.  But what about psychoactive drugs, such as caffeine, or marijuana (ingested, not smoked), or psilocybin mushrooms or LSD or medicines that until Bob Dole were considered unmentionable?  The benefit from these medicines is a positive, not merely the elimination of a negative.  (We are discussing drugs that are not injurious to the body or the mind.)

I suppose that the answer is that Chazal didn't want to create a bracha for any medicine or drug because the vast majority of drugs fall into the first category rather than the second.  (Similarly, it would seem that intravenous administration of nutrition would have exactly the same halacha as food and require a bracha.  But since most intravenous procedures are to administer medication, and when food is given in this manner it is because of some very serious malady, no bracha is said.)

Still, it would seem to me that even though Chazal did not create a nusach of a bracha for these drugs, the Svara, the compelling logic of the bracha, would still apply, and therefore, if one takes recreational drugs, he should stop for a moment and express his gratitude to Hashem for creating these excellent adventures.

I want to point out another thing- do you think this would have been printed in Hapardes or Hamaor?  I don't think so.  Let us thank the internet for this particular quirky aspect of Harbatzas Torah.

15 comments:

dlz said...

Off subject, but your "countdown" to the siyum hashas is now counting backwards.

Barzilai said...

Yow, I didn't notice that. Thanks!

great Unknown said...

Actually, what do you think the bracha על המוגמר was for?

Josh said...

Maybe when Chazal decided there shouldn't be a bracha on medicine, it was to avoid the inevitable bitterness against Hashem one would feel when thanking him for the medicine instead of not giving him/her the disease in the first place.I'm not saying it's a theologically valid feeling, but it is very human. It seems almost cruel to mandate that someone say a bracha every day taking before taking a medicine that makes their life only marginally more bearable. a yehi ratzon beforehand is obviously different, as it's a prayer for recovery, not a thank-you for the medicine.

Barzilai said...

unknown- I don't understand what you're saying. Mugmar was just the smoke from burned spices,and the bracha was atzei/minei besamim. I don't recall anyone saying that mugmar was pot.

Barzilai said...

Josh- inevitable bitterness? A baal bitachon should know that Hashem is just, and that whatever happens is a consequence of Hashem's will, and that the best we can hope for is an appeal to Rachamim through tefilla.

I am always reminded of what happened to Harold Moskowitz, a contemporary of mine that you might know. A few years ago, he felt really unwell, and went to his doctor, who found that he needed immediate bypass surgery, immediate meaning straight from the doctor's office to surgery. His surgeon later commented that the only other place he had seen such badly occluded arteries was in a cadaver he used in medical school, which, of course, had died of a massive heart attack. Harold says he feels he is the luckiest man in the world, because another day and he would have been on the slab.

I used to think that to say he was lucky was like saying that a guy that falls out of a tenth floor window and breaks every bone in his body but survives is also the luckiest man in the world. As Orwell once wrote,

"No one I met at this time — doctors, nurses, practicantes, or fellow-patients — failed to assure me that a man who is hit through the neck and survives it is the luckiest creature alive. I could not help thinking that it would be even luckier not to be hit at all."

I later realized that Harold was right. The intervention was rachamim. The disease was din. He was really lucky. That's what we ask for in Shmoneh Esrei- Hashem's rachamim and refu'ah- and we say a bracha for His merciful intervention.

Josh said...

"A baal bitachon should know that Hashem is just, and that whatever happens is a consequence of Hashem's will, and that the best we can hope for is an appeal to Rachamim through tefilla."

I agree with this. But I am also, baruch Hashem, a reasonably healthy young person. I do not have chronic pain or take medicine regularly. I think someone who is in chronic pain can maybe be excused for a crisis of faith. Forcing someone to thank Hashem for the medicine he has to take every day just to be able to use the bathroom isn't going to make your average person more frum. Perhaps Chazal were just recognizing this as human nature.

Barzilai said...

I understand what you're saying. I inserted the Rama in 204 (about eating under duress) into the post to address that issue in a roundabout manner. But I think most people would naturally have Harold's perspective. Baruch Hashem you have no personal experience, but from what I've seen, the relief of having a cure available trumps the anger at being sick in the first place. George Orwell had an overdeveloped sense of entitlement.

Anonymous said...

How about a diabetic eating cake ? Is it a case of batlei datei etzel rov beni adom? Then what about high cholesterol foods eg gribbinitz which while they taste good are probably not good for anyone?

Barzilai said...

Anonymous, and I wish you'd pick a name, those are tough questions. Rabbi Bodner, in his Vesein Bracha, brings that Reb Shlomo Zalman held that even a medicine that has a good flavor, if you would never eat it if not for the illness, you don't make a bracha, but most poskim hold not like him. He even wasn't sure if a child who is being forced to eat should make a bracha! What does this have to do with cake and gribines? My point is that the din of birkas hane'he'nin is not the regular din of hana'ah like by issurim. Nobody is going to be mattir gribines on Yom Kippur. Birkas hanehenin require willingness. Similarly, it could be that the petur of mazik is broader here, too.

By the way, I vacillate regarding shehakol on shnaps. Nobody drinks it for the flavor; proof- nobody manufactures alcohol-free whiskey. That being the case, it's not being drunk for the hana'ah, but for the effect. Since when do you make a birkas hanehenin on ingesting something for the psychological effect?

great Unknown said...

I protest vehemently. The only reason that a person loses life expectancy by eating gribenes is because he develops such a taste for Gan Eden that he wants to get there as soon as possible. In other words, a variation of misas neshika.

And it's worth it.

Barzilai said...

To Anonymous of September 10 4:03,

I just saw that in the sefer מעון ברכה, he'aros on Brachos from Reb Shlomo Zalman, that regarding the halacha that a person whom wine is mazik should try to push himself to drink arba kosos at the Seder, Reb Shlomo Zalman says that he would not make a bracha on the wine. How do you like that! So it turns out that a diabetic that eats cake, where it is medically proscribed, his bracha would be a bracha levatala. I never would have thought so.
How far do you take this? Forget about Gribenes; oxygen might cause oxidization, but it's good for you to breath anyway. But what about the many other foods we eat that current science tells us are not good for us? Like the kosher margarines and wafers that still have trans-fat? I don't know.

I saw a nice discussion of this topic, which specifically mentions diabetics eating foods that are harmful to them, here:
http://www.hebrewbooks.org/pdfpager.aspx?req=51242&st=&pgnum=157

So I've learned two chiddushim:
Don't make a bracha on a food that is harmful to you (unless, according to some, it tastes very good), and
Don't be maspid someone whose lifestyle and eating habits hastened his death ( http://havolim.blogspot.com/2011/11/chayei-sara-two-from-tur-no-eulogies.html )

great Unknown said...

It's interesting that there appears nobody who uses the approach that since the food is mazik, and there is an issur to be mazik oneself [or at least a bittul asai], that one applies the rule of אין זה מברך אלא מנאץ

Unless that's what the גרע"א meant.

Barzilai said...

It's got to be talking about minor nezek. Venishmartem only involves mortal danger. I am not convinced that bad habits like obesity and smoking are a bittul asei of venishmartem. I know poskim say it does, but how serious are they?

Barzilai said...

You know, I would be interested to see a serious discussion on the extent of venishmartem. Not to make a joke out of the question, one might consider whether it's like a shomer chinam, a shomer sachar, or a sho'eil, and, extending the analogy, might we distinguish between shlichus yad and failure to be vigilant. And what about tchilaso b'pshia..... And if we're making stupid tzushtels, maybe we should be interpreting the term shmira not on the basis of shomrim but on the way it's used in shmiras shabbos. All of this would be fine if we were tana'im. I assume the question has been raised before.