Podcasts about pinhas

As we get into the second part of our Leviticus season, we get to two Leviticus stories written in 140 BCE about how the original priests were violently toppled and replaced by Levites.  Join our tribe on Patreon! Check out these cool pages on the podcast's website:Home PageWho wrote the Bible: Timeline and authorsAncient maps: easy to follow maps to see which empire ruled what and whenClick here to see Exodus divided into "sources" according to the Documentary Hypothesis The podcast is written, edited and produced by Gil Kidron

Today's Talmud pages, Sanhedrin 82 and 83, remind us of our personal responsibility to act when, God forbid, God's very name is being desecrated. Rabbi Dovid Bashevkin joins us to talk about the lessons we can learn from the Biblical hero Pinhas, and why we must never wait for someone else to do what we know we must do ourselves. What profoundly Talmudic insight inspired Teddy Roosevelt? Listen and find out.

durée : 00:32:11 - Talmudiques - par : Marc-Alain Ouaknin - . - réalisation : Alexandra Malka

durée : 00:32:11 - Talmudiques - par : Marc-Alain Ouaknin - . - réalisation : Alexandra Malka

durée : 00:58:36 - Le Cours de l'histoire - par : Xavier Mauduit, Maïwenn Guiziou - Quand une enfant grandit à Istanbul, environnée du turc, de l'allemand de sa mère, du français de son père, du latino de sa grand-mère judéo-espagnole, et qu'elle découvre plus tard l'hébreu, cela donne une multiplicité de langues, de cultures et d'histoire, qui mène de l'écriture à la traduction. - réalisation : Laurence Millet - invités : Rosie Pinhas-Delpuech Écrivaine et traductrice

e read in Parashat Matot of the war that G-d commanded Beneh Yisrael to wage against the nation of Midyan to avenge the tragedy of Ba'al Pe'or. Midyan, together Moav, conspired to lure Beneh Yisrael to sins of immorality and idol-worship. The scheme, unfortunately, succeeded, and G-d punished Beneh Yisrael by sending a plague that killed 24,000 members of the nation. Hashem instructed Beneh Yisrael to wage war against Midyan in order to take revenge. The Torah relates that this battle was led by Pinhas, the son of the Kohen Gadol, Elazar (31:6). Rashi gives two reasons for why specifically Pinhas was chosen to lead the war. First, he was the one who saved Beneh Yisrael from annihilation during the calamity of Ba'al Pe'or, by killing a man and woman who committed a public sinful act. Once Pinhas avenged G-d's honor, G-d ended the plague. Rashi writes that since Pinhas began the Misva by killing these two violators, he was chosen to complete the Misva by leading the war against Midyan. But then Rashi adds a second explanation. He writes that Pinhas led the war against Midyan to avenge that nation's role in the sale of his ancestor, Yosef, as a slave. Pinhas' mother was a descendant of Yosef, and merchants from Midyan were the ones who, after purchasing Yosef from his brothers, brought him to Egypt and sold him to Potifar, an Egyptian nobleman. It was thus appropriate for Yosef's descendant, Pinhas, to lead Beneh Yisrael's war against the people of Midyan. Rashi's comments seem puzzling. Why should Midyan be blamed for Mechirat Yosef (the sale of Yosef as a slave)? It was Yosef's brothers who turned on him; the Midyanim simply accepted the offer and paid for Yosef, after which they sold him for a profit. Why did their role in Mechirat Yosef need to be avenged? Yosef excelled particularly in the area of Kedusha, maintaining his sanctity and purity even in the face of overwhelming temptation. As a teenager, he was lured to sin by Potifar's wife, and he resisted. The Midyanim, it appeared, had sinister intentions when they brought Yosef to Egypt, a society which at that time was steeped in decadence and immorality. They wanted to ruin Yosef by compromising his Kedusha, by putting him in a place where – they incorrectly assumed – he would be unable to withstand temptation and would be lured to sin. This is precisely what Midyan did several generations later, at Ba'al Pe'or. They tried destroying Beneh Yisrael by luring them to immorality, which would undermine their spirituality. Appropriately, then, Pinhas – a descendant of Yosef – led the war against Midyan, because this war avenged Midyan's devious scheme both at Ba'al Pe'or and with Mechirat Yosef. Our nation's struggle against Midyan continues to this very day, with greater intensity than ever. Contemporary society champions values that directly oppose the Torah's values of Kedusha and purity, and we are exposed at all times to lures that threaten to divest us of our sanctity. Hashem commanded Beneh Yisrael to wage war against Midyan – because we need to proactively reject and oppose the efforts made to undermine our Kedusha. We must continue waging this vitally important battle that began with Yosef and then proceeded with Pinhas, and work to oppose the sinful influences and lures that we face on a daily basis.

Après les larmes le sourire (Pinhas) by Rav David Touitou

On n'oublie jamais le nom d'un Tsadik (Pinhas) by Rav David Touitou

Paracha Pinhas 5784 (2024) - Message du Rav avant Shabbat by Rav David Touitou

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Histoire autour de la paracha Pinhas

Chiour sur la paracha Pinhas

'When wealth is lost, nothing is lost; when health is lost, something is lost; when character is lost, all is lost.' --German Proverb ------------------------- #201: On Character & Reputation Welcome to this week's episode! We explore the powerful dynamics of character and reputation in leadership. Learn from the compelling story of Pinhas and Zimri. Discover how actions shape public perception and the lasting impact of integrity. Key Takeaways: Character vs. Reputation: Understand the core differences. Real-Life Examples: Mandela's legacy vs. Madoff and Lance Armstrong's downfall. Actionable Insights: Tools for self-reflection and ethical growth. Tune in now and start leading better! happy learning!

Pinhas 2024

Parashat Pinhas is almost always read on the first Shabbat of the period known as “Ben Ha'mesarim,” the three weeks between Shiba Asar Be'Tammuz and Tisha B'Ab, when we mourn the destruction of the Bet Ha'mikdash. With very rare exceptions, the first Shabbat after the fast of Shiba Asar Be'Tammuz is the Shabbat when we read Parashat Pinhas. We might therefore expect to find some connection between this Parasha and the period of mourning for the loss of our Mikdash and our banishment into exile. I would like to suggest a possible point of connection, by way of a concept that emerges from a halachic discussion in the Gemara concerning our three daily prayers. The Gemara in Masechet Berachot (27b) brings a debate among the Tanna'im regarding the status of the evening Arbit prayer, whether it is obligatory or optional. According to Rabbi Yehoshua, “Tefilat Arbit Reshut” – Arbit is optional. Whereas the recitation of Shaharit in the morning and Minha in the afternoon constitutes an outright Halachic obligation, one is not required to recite Arbit. Halacha actually follows this opinion, in principle, though in practice, the Jewish Nation has accepted the Arbit prayer as an obligation. What is the difference between the Arbit prayer and the other two daily prayers? Why would Arbit be optional, while the others are obligatory? Earlier (26b), the Gemara brings a different dispute, as to the origin of the daily prayers. According to one opinion, “Tefilot Abot Tiknum” – the prayers were instituted already by our patriarchs. Abraham Abinu established the morning Shaharit prayer; Yishak introduced the afternoon Minha prayer; and Yaakob instituted Arbit. It has been suggested that these three symbolize three different sets of circumstances. Abraham Abinu is associated with morning because he enjoyed a great deal of blessing and good fortune. And, like the morning sun, his success grew brighter with time. As he aged, he attained greater wealth and earned greater prestige. Yishak, by contrast, resembled the afternoon, as he, too, enjoyed great wealth and prosperity, but then his “light” of good fortune began declining. As he aged, he endured adversity at the hands of the Pelishtim, and lost his vision. His life thus resembles the waning afternoon sunlight. Yaakob Abinu instituted the evening Arbit prayer because his life was, to a large extent, characterized by “darkness.” He endured numerous travails, as he was pursued by his violent brother, and forced to flee and live with his wily, corrupt uncle. Later, his daughter was abducted and defiled, and one of his sons was sent away as a slave by his other sons. His family then suffered terrible famine. The Arbit prayer, established by Yaakob Abinu, represents the prayers recited during the “night,” in periods of darkness and hardship. And precisely for this reason, some have explained, this prayer is (in principle) optional. We believe that all periods of darkness are temporary and fleeting. Halacha does not, strictly speaking, require reciting the nighttime prayer because “nighttime” does not last; whatever adversity we currently face will soon give way to the light of joy and good fortune. There cannot be a strict obligation to recite Arbit because this prayer will not always be needed; any darkness that we and the world experience is temporary. With this in mind, let us return to Parashat Pinhas. The latter part of this Parasha is devoted to the special sacrifices required during the holidays in the Bet Ha'mikdash. The Torah here goes through all special occasions – Shabbat, Rosh Hodesh, Pesach, Shabuot, Rosh Hashanah, Yom Kippur, Sukkot and Shemini Aseret – detailing the sacrifices that are to be offered on each occasion. Of course, the occasion of Tisha B'Ab does not appear in the Torah, because this occasion was not supposed to be established; we were expected to always be worthy of the Bet Ha'mikdash, such that it would never be destroyed. Perhaps, we read this Parasha during the period of Ben Ha'mesarim to remind ourselves that although we observe Tisha B'Ab every year, this observance is temporary. We read this Parasha specifically so we take note of the fact that Tisha B'Ab is “missing,” that this day is not meant to be an annual occasion. This reading thus assures us that the darkness of our current exile will soon give way to light, that the adversity that we and our nation face will end, and we will experience the joy and elation of our final redemption, may it arrive speedily and in our times, Amen.

On n'oublie jamais le nom d'un tsadik (Pinhas) by Rav David Touitou

Parashat Pinhas begins with Hashem's announcement of the rewards that He would be giving to Pinhas, the grandson of Aharon. The background to the story is the sin of Ba'al Pe'or , when Beneh Yisrael became involved with the women of the nation of Moav, and also worshipped the god of Moav. Hashem punished the people by bringing a plague which killed 24,000 people. The plague ended only when Pinhas boldly arose and killed two people – a Jewish man and a gentile woman – who were committing a public sinful act. By defending Hashem's honor in this way, Pinhas brought an end to the devastating plague. Hashem then announced that Pinhas would receive two rewards. First, he would receive בריתי שלום – “My covenant of peace.” He was blessed with peace and serenity. In addition, he was rewarded with ברית כהונת עולם – the status of kohen . Due to a technicality, Pinhas had not previously been a kohen , despite being a grandson of Aharon. In reward for his heroic act during the calamity of Ba'al Pe'or , he and his descendants were declared kohanim . It seems that Pinhas received two rewards because of two great things which he accomplished. The Midrash tells that after he killed the two violators, he turned to Hashem and asked, “Because of these two people You are going to kill 24,000 members of Beneh Yisrael ?!” This shows that Pinhas acted as he did not out of anger and rage, but to the contrary, out of genuine love and concern for Am Yisrael . He truly believed, with every fiber of his being, that Beneh Yisrael were much better than this, that this debacle didn't at all define who they were. There were these two sinners who needed to be eliminated, but the rest of the nation were all good and deserved to be saved. This is how Pinhas felt toward Beneh Yisrael. Pinhas thus received two rewards: 1) He was rewarded with the status of kohen for his bold, courageous act to kill the two sinners. 2) He was rewarded with peace for his sincere love and concern for the people. Pinhas wasn't an angry, mean zealot who set out to violently oppose those who acted wrongly. Rather, he deeply cared for Beneh Yisrael even in their moment of disgrace. He realized that there were two “bad apples” whom he needed to confront for the sake of saving the rest of the nation. This was an act of love, not an act of rage. Tens of thousands of people sinned – but he loved them, and acted against only the two public violators. Rav Binyamin Finkel of the Mir Yeshiva in Jerusalem is an extraordinary figure, commonly known as “Rav Binyamin Ha'tzadik.” Once, when he visited our community, he came to shul on what turned out to be an exceptionally busy Shabbat morning. A lengthy, double- parashah was read, and a fundraiser was being held. There were lots of extra aliyot , and the shul was extremely noisy, with lots of talking. Before the time came for him to speak, I had no choice but to approach him and explain that the people in the shul are very strict about time, and so he had only three minutes, and no more, to speak. The words he spoke in those three minutes left me astonished. He spoke about how wonderful the shul is, how wonderful the congregation is, how wonderful the tefilah was. This man is the mashgiah (spiritual supervisor) of the Mir Yeshiva, where hardly anybody speaks a single word during the tefilah , ever. And here he was, in a commotion-filled shul with lots of noise, talking about how wonderful the people were. Rav Binyamin understood that the way to people's hearts is through positivity, not through negativity and criticism. Angrily berating people for doing things wrong is not likely to change them. It will just make them not want to listen to what we have to say ever again. If we want to elicit change, we need to treat people and speak to them with respect even if they do things to which we strongly object. In the early years of our community, there were many members who would drive to work after davening on Shabbat morning. The Rabbis of the time did not throw them out of shul. They did just the opposite – they warmly welcomed them, understanding that their ongoing connection to the shul, to tefilah , and to the Rabbi is what will gradually influence them to raise their standards of religious observance. Pinhas is not a model of angry zealotry, of harshly protesting against sin. He is a model of love and positivity, of caring for fellow Jews especially in their lowest moments. This is the way our community will, please G-d, continue to grow and flourish – through positivity, through love, through building connections between the different types of people, so that we can work together to move our community forward.

Commentaires sur la paracha Pinhas

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It's kind of scary--or relevant--when the news corresponds to something in the Torah in the same week. It's about anointing, but it's relevant who is being anointed. How do we know when something is ordained by God? Take a listen and leave a comment!

Briser son être pour mieux exister (Pinhas) by Rav David Touitou

Les sages ont 1 point commun avec les serpents (Pinhas) by Rav David Touitou

latestLatest episode of the podcast. Please consider sponsoring a class online in someones merit, memory or refuah shelemah. You can donate here in the app or send us an email at info@ejsny.org with the dedication you want to make. Thanks! --- Support this podcast: https://podcasters.spotify.com/pod/show/rabbifarhi/support

We start off our collection of conversations from exocad Insights 2024! This week features Jaime Moreno from Spain, Saulius Janusevicius from Lithuania, Alex Chabachevitch from Canada, and Pinhas Adar from the US. Join the GOLDEN BENCH CLUB! All you have to do is leave us a 5-star review and comment on the Apple Podcast app (or any other app and email us a screen shot) and we will read your review on the podcast and welcome you to the Golden Bench Club. This super elite club is only for the best of the best. This week we start with the conversations we got while in Mallorca, Spain recording at the exocad Insights 2024 meeting. THANK YOU exocad (https://exocad.com/) for inviting us to this amazing meeting. It's held every two years, so go ahead and plan on attending in 2026! First up with talk with a certified exocad trainer, Jaime Moreno. Jaime talks about his boutique lab, the technology he uses, and common questions a trainer gets. Jaime is also the gentleman that took time out of his busy schedule to go to the Barcelona airport lost and found, pick up my laptops, box them, and ship them. He is the hero that has made every conversation from exocad Insights possible to be released. Then we chat with Saulius Janusevicius & Alex Chabachevitch. These two technicians meet at exocad Insights two years ago and have remained friends since. Saulius is from Lithuania and Alex is from Canada but found a common likeness for teeth and exocad. They talk about their journey into dental technology, what they specialize in now, and what they get out of going to exocad Insights. Then we wrap up the episode with Pinhas Adar. Pinhas owns a lab in Atlanta, Georgia. But his story starts at the age of 14 in Israel. Pinhas talks about his amazing journey, people that have influenced him along the way, and how he can charge the same for a full arch and a single unit. On September 11th in Fort Worth, Texas, the 10th annual Race For the Future (https://dentallabfoundation.org/news-events/race-for-the-future/) will take place to raise money for the Foundation For Dental Laboratory Technology (https://dentallabfoundation.org/). Barb is doing her 9th solo race and Elvis is teaming up with Mark Williamson and Bobby Kenney to form The Abutments. Go to dentallabfoundation.org and click on the DONATE TODAY button. There you need to log in or create an account. Then select “Race for the Future” and enter the name of either Barb Warner or the Abutments, then the amount you want to donate. Wanting to take your knowledge and skills to the next level? If you are looking for the best education dedicated to dentistry in both the labs and clinics, check out Ivoclar Academy. (https://resources.ivoclar.com/lab/en/academy) From on-demand webinars to in-person training, Ivoclar Academy has a program to meet your busy schedule. Check out all they have to offer HERE! (https://resources.ivoclar.com/lab/en/academy) Special Guests: Alex Chabachevitch, Jaime Aisa Moreno, Pinhas Adar MDT, CDT, and Saulius Janusevicius.

We're now in Mishleh 28, 25 רְחַב־נֶ֭פֶשׁ יְגָרֶ֣ה מָד֑וֹן וּבֹטֵ֖חַ עַל־יְהֹוָ֣ה יְדֻשָּֽׁן׃ A Rechav Nefesh/greedy person stirs up strife. But one who relies on Hashem will have abundance. That's the simple Artscroll definition of the pasuk. And now for the commentaries… “Rechav Nefesh ” is a term used in Pirkei Avot , where Bilaam, is described as having a ‘ Nefesh Rechava ,' which means he's a Baal Ta'ava, a man of desire. That's a Nefesh Rechava, Yigareh Madon/ stirs up strife.. Rashi says he brings upon himself Middat HaDin/God's justice. [When a person just indulges his own pleasures and is selfish, that arouses God's judgment on him. But a person who's selfless is someone that's giving, which brings God's mercy upon him. It's not really our topic, but it's an important point.] וּבֹטֵ֖חַ עַל־יְהֹוָ֣ה The one who relies on Hashem is יְדֻשָּֽׁן Yedushan , which the Mesudat Sion says is a term of being anointed with oil, as it says in Tehilim 36 יִ֭רְוְיֻן מִדֶּ֣שֶׁן בֵּיתֶ֑ךָ That's the simple explanation. The Gaon of Vilna explains that a man of desire is someone who's not happy with his lot. He's always angry because everything is too small or not enough, and therefore, he lives a miserable life. And since he's always angry, the smallest thing is going to tick him off, so he's going to get into arguments. But the one who relies on Hashem is the opposite. He is Sameach B'Helko/happy with his lot . He's happy with what he has, so he's in a state of tranquility because he's in a world of completeness. The Malbim says that this man is not only going to get into arguments with people because he's not in the right mood, he's going to start having complaints against God, because he looks at everything in the world as going wrong. He's constantly complaining. Conversely, the one who relies on Hashem, who is not being pushed by his desire, who is happy with what Hashem gives him is going to find what he needs. That's all on what we call the pshat level. The sefer Zera Yaakov, written in the 1700s by Rabbi Yaakov Ben Haim HaKohen, says Rechav Nefesh is referring to Zimri ben Salu, a man of desire who sinned with Kozbi. He caused arguments. He caused arguments with Moshe Rabbenu, and he caused 24,000 people to die. He caused arguments between God and the Jewish people. He says the Bote'ach al Hashem, the one that relied on Hashem, was Pinhas. Pinhas was zealous and killed them both, and he got wonderful blessings from Above. He says, Yodushan refers to the portion of the Mizbe'ach called the Terumat HaDeshen, where they put the pile of ashes. It says, all the blessings came to the Jewish people from the korbanot . So Pinhas, the one that relied on Hashem, merited to become a Kohen Gadol, and brought an abundance of blessings upon the Jewish people through the Korbanot . That's more of a Midrashic reading into our pasuk. There's a very interesting point in this pasuk, which goes back to the Hovot Halevavot in Shaar HaBechina where he discusses why it is that people don't see God creation. He also says, in Shaar Bitachon, that this interferes with our reliance on Hashem. If we don't see Hashem in creation and we don't see how He's taking care of us, we don't rely on Him. He says it comes because of our great desire for more. We're always looking at what we don't have and not at what we do have. We can't see God, because we only see what we don't have. As the famous question goes, Is the cup half empty or half full ? Half empty is the man of Ta'ava . He only sees what he doesn't have. Nothing satisfies him. On the other hand, the Baal bitachon is a man who's able to slow down and see and appreciate what he has, and see how God has been taking care of him until now, in all the wonderful things that he has. He can truly feel like he's bathing in the goodness of God. This is a fundamental- we should not be looking for more, but rather, appreciating what we have. This is actually a prerequisite for bitachon because if a person is always complaining, bitachon doesn't do anything. They think, My life is miserable, but their life is not as miserable as they think it is. The cause is the Middah of desire , always looking for what you don't have, desiring more worrying about what the Joneses have, etc. This is a beautiful lesson. Mishleh is always about opposites. One would not simply say that the opposite of bitachon is a Nefesh Rechava, a greedy person that's chasing his desire . That's our pasuk for the day. רְחַב־נֶ֭פֶשׁ יְגָרֶ֣ה מָד֑וֹן וּבֹטֵ֖חַ עַל־יְהֹוָ֣ה יְדֻשָּֽׁן׃ The man who's greedy causes arguments. And one that relies on God will have abundance.

We are now in Pesukei Bitachon, Tehilim 115,11 יִרְאֵ֣י יְ֭הֹוָה בִּטְח֣וּ בַיהֹוָ֑ה עֶזְרָ֖ם וּמָגִנָּ֣ם הֽוּא׃ Those that fear Hashem rely on Hashem. He is their help and their shield. What is the connection between those that fear Hashem and those that rely on Him? Rabbenu Bachye in Bamidbar 25,11 tells us it's known that Fear of Hashem is a stepping stone to Bitachon. We have to start with fear of Hashem, which is the realization that Hashem is here. Fear of Hashem doesn't mean that you walk around shivering all day. Fear of Hashem means you realize Hashem is here. Rav Wolbe, as well as others, says that יראה Yirah / fear has the same letters as ראה Ra'ah / to see , which means fear of Hashem means you're aware of Hashem and therefore you don't want to sin because He's watching me . And ultimately, if I'm aware of Hashem and know He's here, then I rely on Him. That's why יִרְאֵ֣י יְ֭הֹוָה בִּטְח֣וּ בַיהֹוָ֑ה those that fear Hashem rely on Hashem. Rabbenu Yonah, in his Igeret HaTashuva , unit 70, says that the more fear of Hashem you have, the stronger your reliance on Hashem becomes, and he quotes our pasuk: יִרְאֵ֣י יְ֭הֹוָה בִּטְח֣וּ בַיהֹוָ֑ה Rabbenu Yonah, in Mishleh 18,10 asks why we single out that Yireh Hashem rely on Hashem, and he says it's because the reliance of people that fear Hashem is a different level of reliance. Furthermore, the Chatam Sofer points out that the rule is that we always go up in the levels of holiness. The pesukim start off with Yisrael Betach B'Hashem . Yisrael is the base level. Just the fact that he identifies as a Jew is something, as we previously discussed. Then there's the Bet Aharon Bitchu B'Hashem , those are the Kohanim . That's the next level. But the highest level is Yireh Hashem , those that fear Hashem. One of the greats in our Torah is Pinhas, somebody who put his life on the line, someone that had Yirah and Bitachon . Rabbenu Bachye, in Bamidbar 25,11 says that Pinhas was a God-fearing man and also a Bote'ach B'Hashem and his reward for killing Kozbi and Zimri was (Malachi 2,5) בְּרִיתִ֣י ׀ הָיְתָ֣ה אִתּ֗וֹ הַֽחַיִּים֙ וְהַשָּׁל֔וֹם / My covenant was with him- Life and Shalom He got life. He lived forever, and he got peace. These are really connected. Living forever comes from the fact that your body is at peace with itself. His body and soul never separated. Rabbenu Bachye says he got these two rewards, peace and life, because he had the traits of Yirah and Bitachon . What is a greater reward than life and peace? Of course, we want to live but we know that without peace, what is life? We're learning that these two levels, fear of Hashem and reliance on Hashem, give us the two greatest gifts that we can ask for: HaChaim V'HaShalom. And it builds on itself, as we said. The the more fear of Hashem we have, the more reliance on Hashem we have. The Chatam Sofer says in Shemot 18,23 that Yirat Shamayim comes from learning Torah. This point was a bit of a hiddush to me. We talk a lot about relying on Hashem, but there's a process. You need to work on Yirat Shamayim/ Fear of Hashem in general. We learn this from Yosef HaSadik who controlled himself from sinning with his boss's wife. He had Yirat Hashem . He said, I don't want to sin to God . He is also the role model of bitachon/reliance on Hashem, because you can't just jump to relying on Hashem. You rely on Hashem if you're aware of His presence. And if you're aware of His presence, then you also follow His rules and regulations and don't sin, so Bitachon needs Yirat Shamayim. We shouldn't fool ourselves. We know that bitachon is elusive, so we really have to say to ourselves, If we have real bitachon, it should come with real Yirat Shamayim as well. Have a wonderful day.

The rise of Pini Zahavi. Pinhas "Pini" Zahavi is an Israeli football agent.

Paracha Pinhas - Les Pin'has des temps modernes (selon le Rabbi) by Rav David Touitou

Paracha Pinhas 2023 - Message du Rav avant Shabbat by Rav David Touitou

Pinhas Tammuz 17 2023

Chiour donné par Rav Israel Abib Chelita. Rav Israel Abib dirige les institutions Yeshiva Ohavei Torateha (Tocqueville Paris - Raanana) ainsi que le site dafhayomi.fr qui diffuse quotidiennement les chiourim de daf hayomi dispensés par la Yeshiva. Retrouvez l'ensemble des chiourim du Rav (Paracha, Éducation, Hagim, Moussar.... ) sur www.dafhayomi.fr rubrique "PARACHA EN 10 MIN".

Rabbis Eliot Malomet, Barry Chesler and Jeremy Kalmanofsky bring us Parsha Talk - broadcast directly from Ramah Berkshires in Wingdale!

La jalousie de Pinhas et de Korah (selon le Baal Chem Tov) by Rav David Touitou

The Torah in Parashat Pinhas tells about the census taken of Beneh Yisrael shortly before they crossed into the Land of Israel. We find in the Torah's account of this census a list of the families of each tribe. The tribe of Yissachar, for example, consisted of four families, established by the four sons of Yissachar – Tola, Puva, Yashub and Shimron (26:23-24). The Or Ha'haim Ha'kadosh (Rav Haim Ben-Attar, 1696-1743) comments that the name “Yissachar,” and the names of his sons, actually convey to us various lessons relevant to Torah learning. Tradition teaches that the tribe of Yissachar devoted itself to learning and became outstanding scholars, and were supported by the people of the tribe of Zebulun, who worked as merchants and shared their earnings with the scholars of Yissachar. The name “Yissachar,” the Or Ha'haim writes, represents the phrase “Yesh Sachar” – “there is reward,” indicating to us that the greatest reward we can earn is the reward for immersion in Torah study. Likewise, the names of Yissachar's sons, which then became the names of the families of this tribe of scholars, teach us about the way to approach the pursuit of Torah scholarship. Yissachar's first son is called “Tola,” which means “worm.” This alludes to the quality of humility, which is vital for succeeding in learning. Moreover, the silkworm produces precious silk from its mouth – a symbol of how much one can achieve and produce through his mouth, by speaking words of Torah. Yissachar's second child is named “Puva,” which is related to the word “Peh” – mouth, but with the letter “Heh” substituted with a “Vav.” The Or Ha'haim notes that according to the wisdom of Kabbala, the letter “Vav” is associated with Torah, and thus the name “Puva” expresses the quality of utilizing one's mouth for Torah learning. The family that descended from this son is known as the “Puni” family, a word that resembles “Panui” – cleared, or emptied. In order to attain Torah scholarship, one must reduce his indulgence in food, and in idle chatter and frivolity, “clearing” his mouth so that it can be used exclusively to speak the sacred words of the Torah. The name “Yashub,” the Or Ha'haim writes, alludes to “Yeshiba” (literally, “sitting”), the need to devote a great deal of time and effort to Torah study. The Or Ha'haim explains that “Yeshiba” connotes permanence, consistent attendance and regular learning, as opposed to an occasional visit to the study hall. This commitment is an indispensable prerequisite to achievement in Torah learning. Finally, the fourth son is called “Shimron,” a name derived from the root “SH.M.R.,” which means “guard.” A student of Torah must exercise extreme care in all his behavior, to ensure to not even appear to act improperly. The Gemara in Masekhet Yoma (86a) tells of certain great Sages who refrained from activities which are, in and of themselves, perfectly acceptable, but could be misunderstood as inappropriate. A student of Torah must see himself as a representative of Torah, as an ambassador, because this is how others see him. His behavior will help shape other people's opinion of Torah and of dedicated religious Jews. And thus one of Yissachar's children was named “Shimron” – emphasizing the importance of “Shemira,” of guarding oneself to ensure that he does not do anything which could potentially reflect negatively on the Torah and its adherents.

This is the Weight and Healthcare newsletter! If you like what you are reading, please consider subscribing and/or sharing!The American Academy of Pediatrics has put out a new Clinical Guideline for the care of higher-weight children. This document is 100 pages long including references and there are so many things that are concerning and dangerous in it that I had trouble deciding how to divide it up to write about it. I began on Thursday with a piece about the undisclosed conflicts of interest. Ultimately for today, I decided to focus on what I think will do the most harm in the guidelines, which is the recommendations for body size manipulation of toddlers, children, and adolescents through intensive behavioral interventions, drugs, and surgeries.A few things before we dive in. First, this piece is long. Really long. I thought about breaking it up to make it easier to parse, but I also know that people are (rightly) very concerned about these guidelines and I didn't want to trickle information/commentary out over days and weeks in case it might be helpful to someone now. Also, know that this may be emotionally difficult to read, in particular for those who have been harmed by weight loss interventions foisted on them as children. That will likely be exacerbated by the gaslighting these guidelines do to erase the lived experience of harm and trauma from the “interventions” they are recommending, and from their co-option of anti-weight-stigma language to promote weight loss. So please take care of yourself, you can always take a break and come back. Per my usual policy I will not link to studies that are based in weight bias and the weight loss paradigm, but will provide enough information for you to Google if you want to read them. I'll also use an asterisk in “ob*sity” for the reasons I explain in the post footer. Ok, big breath and let's get into this.In later newsletters, I'll address other issues in depth, but for now here are some quick thoughts and links about overarching issues before I dig into the actual recommendation:The claim that “ob*sity is a chronic disease—similar to asthma and diabetes”No, it's really not. And it's this faulty premise (that having a body of a certain size is the same thing as having a health condition with actual identifiable symptomology) that underlies everything in these guidelines. The diagnosis of asthma requires documentation of signs or symptoms of airflow obstruction, reversibility of obstruction (improvement in these signs or symptoms with asthma therapy) and no clinical suspicion of an alternative diagnosis. The diagnosis of diabetes requires a glycated hemoglobin (A1C) level of 6.5% or higher. But to diagnose “ob*sity” you just need a scale and a measuring tape. A group of people with this “diagnosis” don't have to share any symptoms at all, they simply have to exist in their bodies. That is not the same as asthma or diabetes, though the weight loss industry (in particular pharmaceutical companies and weight loss surgery interests) have absolutely poured money into campaigns to try to convince us that it is. (Note that the argument that ob*sity is correlated with other health conditions and thus is a disease actually proves the fallacy since some kids/people who are “diagnosed” with “ob*sity” don't have any of those health conditions and some kids/people who are thin do have them. It's especially disingenuous as it ignores the confounding variables of weight stigma and, in particular, weight cycling both of which these guidelines, if adopted, are very likely to increase.)The myth of “non-stigmatizing ob*sity care” Like so much of these guidelines, this idea and much of the verbiage around it mirrors that of the weight loss industry. In this case, it's attempt to co-opt the language of anti-weight-stigma in order to promote (and profit from) weight loss (there's a guide to telling the difference between true anti-stigma work and diet industry propaganda here!) In truth, there is no such thing as non-stigmatizing care for ob*sity, because the concept of ob*sity is rooted in size and the treatment is changing size (the word was made up to pathologize larger bodies, based on a latin root that literally means to eat until fat so…less science than stereotype there.) There is no shame in having a disease, it's just that existing while fat isn't one. The concept of “ob*sity” as a “disease” pathologizes someone's body size. The concept of ob*sity says that your body itself is wrong, and requires intensive therapy and/or risky drugs and surgeries so that it can be/look right. There is no way to say that without engaging in weight stigma.If someone claims that the treatment is actually about health and not size, then it's not “ob*sity” treatment since both the criteria for the “disease” and the measure of successful “treatment” of ob*sity are based on body size. If the treatment is about health and not size, then the treatment and measures of success should be about actual metabolic health, not body size (which would be ethical, evidence-based, weight-neutral care.)The idea that “It is important to recognize that treatment of ob*sity is integral to the treatment of its comorbidities and overw*ight or ob*sity and comorbidities should be treated concurrently”Again, I think this is demonstrably untrue. Any health issues that are considered “comorbidities” of being higher-weight are also health issues that thin people get, which means that they have independent treatments. We could skip body size manipulation attempts entirely and still treat any health issues that a higher-weight child/adolescent has.The dubious claim that “ob*sity treatment” is compatible with eating disorders preventionI wrote a specific piece about this here. Weight loss as a “solution” to weight stigmaThis is unconscionable. Regardless of what someone believes about weight and health, the message that children (as young as 2!) should solve stigma by undertaking intensive and dangerous interventions that risk quality of life moves beyond inappropriate to disgusting, especially when one is perpetuating weight stigma, as these guidelines (and the weight loss industry talking points that are repeated herein) do.There is so much more to unpack here, but I want to move into a discussion of the recommendations themselves.For this, I will start where I left off on the conflict of interest piece. Which is to say, almost all of the authors of these guidelines are firmly entrenched in the body-size-as-disease paradigm. They have pinned their careers to it. None of the authors are coming from a weight-neutral paradigm.  In fact, in the research evaluation methodology section, they explain that they excluded studies that looked at impacting health, rather than weight. In their own words:The primary aim of the intervention studies had to be examination of an ob*sity prevention (intended for children of any weight status) or treatment (intended for children with overw*ight or ob*sity) intervention. The primary intended outcome had to be ob*sity, broadly defined, and not an ob*sity comorbidity.Note that by “ob*sity comorbidity” they mean a health condition that happens to children of all sizes.I don't know if it was intentional, or just a myopic focus on body size manipulation as a supposed healthcare intervention, but the option to focus on health rather than size was specifically excluded by a group of authors whose careers on based on focusing on size.There are three main areas of their recommendation that I'll talk about today - Intensive Health Behavior and Lifestyle Treatment, Weight Loss Drugs, and Weight Loss Surgeries.RECOMMENDATION:  Intensive Health Behavior and Lifestyle Treatment (IHBLT)This is recommended starting as young as age two. That's right, they are recommending intensive interventions to kids in diapers (and they think that they should look into how to “diagnose” kids who are even younger, yikes!) What these guidelines subtly admit is that these interventions don't actually work. They include this (long-time weight loss industry) talking point “a life course approach to identification and treatment should begin as early as possible and continue longitudinally through childhood, adolescence, and young adulthood, with transition into adult care.”The translation to this is that they have absolutely no idea how to make higher-weight people of any age thin long-term. They are aware (and if not they are negligent) that a century of data shows that the vast majority of people will lose weight short-term and gain it back long-term. What they seem to be trying to do here is rebrand yo-yo dieting (aka weight-cycling) as a successful intervention. If there is a prize for moving the goalpost and declaring victory, they are in the running.Don't just take my word for it, they created a graphic as part of Figure 1 to show it:Pro tip: When they say “relapsing remitting” they mean “yo-yo dieting". I know why the weight loss industry loves this idea - it's how they've built a business that creates exponential growth with a product that doesn't work. What I don't understand is how this group of authors can possibly justify this ethically. The health risks of weight cycling are documented (and very consistent with the health risks that get blamed on higher-weight bodies) so setting people up for weight cycling starting as toddlers does not, to me, have the ring of sound science or ethical, evidence-based medicine.Let's dig into the evidence they are using to support this:The guidelines claim that “IHBLT is the foundational approach to achieve body mass reduction or the attenuation of excessive weight gain in children. It involves visits of sufficient frequency and intensity to facilitate sustained healthier eating and physical activity habits.” The study they cite to back this up (Grossman et al; 2017, Screening for ob*sity in children and adolescents: US Preventive Services Task Force recommendation statement) says “Comprehensive, intensive behavioral interventions (≥26 contact hours) in children and adolescents 6 years and older who have ob*sity can result in improvements in weight status for up to 12 months.”They also include a chart of seven randomized controlled trials (RCTs) from 2005-2017. The combined study population of all seven studies was just 1,153 kids. The largest study (with 549 participants) and the only study to include children from ages 2 to 5 had a duration of 12 months and showed a BMI change of 0.42 that year, and was only “effective” (if you consider a .42 change in a year “effective”) in kids ages 4-8 years old. There was only one study that followed up for more than 12 months, and from 12 months to 24 months, the BMI change decreased (from 3.3 to 2.8,) consistent with the weight regain pattern that we would expect.This will be a running theme in these guidelines - short-term studies will be used to justify life-long recommendations, and weight regain is ignored. In general, sometimes this is based on the idea that if a weight loss intervention works short-term, then it will continue to work forever, other times it's based on the idea that weight cycling is an ethical, evidence-based healthcare intervention. Again, the data on both the long-term failure of weight loss and the danger of weight cycling does not support this.They make a point to mention that IHBLT “involves interaction with pediatricians and other PHCPs who are trained in lifestyle-related fields and requires significantly more time and resources than are typically allocated to routine well-child care.” At this point I'll note that many of the authors of the guidelines run clinics or have practices that provide exactly this type of care.Their criteria for the studies was, I'll just call it lax: “Over a 3-12 month period: The criteria for the evidence review required a weight-specific outcome at least 3 months after the intervention started.” Obviously, this is a very short-term requirement and, again, excludes studies that looked at actual health instead of just body size.Here again they tell on themselvesTreatments with duration longer than 12 months are likely to have additional and sustained treatment benefit. There is limited evidence, however, to evaluate the durability of effectiveness and the ability of long-term treatments to retain family engagement.Note that the idea that longer duration treatment is “likely” to have additional and sustained treatment benefit is not remotely an evidence-based statement, and I would argue that it is biased and should not be included here. Also, they seem to be setting the stage for blaming families for the entirely predictable and almost always inevitable weight regain.Under “referral strategies” they get real about how little weight loss we're actually talking about:Pediatricians and other Primary Healthcare Providers (PHCP's) are encouraged to help to set reasonable expectations for these [BMI-based] outcomes among families, as there is a significant heterogeneity to treatment response and there is currently no evidence to predict how individual children will respond. Many children will not experience BMI improvement, particularly if their participation falls below the treatment threshold.”As described in the Health Behavior and Lifestyle Treatment section, those who do experience BMI improvement will likely note a modest improvement of 1% to 3% BMI percentile decline.So they are recommending an “intensive,” time-consuming, expensive intervention to kids starting as young as age 2 with no prognostics as to which kids might be “successful,” the stated result of which is that “many” (their word) of them won't experience any change in the primary outcome, those who do will see a very small change.They do mention the supposed actual health benefits of these interventions, but fail to mention that the health benefits may have nothing to do with the very small change in size. That's because often when health changes and weight changes (at least temporarily) follow behavior change, those who are invested in the weight loss paradigm (financially, clinically, or both) are quick to credit the weight change, rather than the behavior change, for the health change. Here again, the evidence does not support this. It's very possible that these same health improvements could be achieved with absolutely no focus or attention paid to weight, which would provide more benefits and less risks (including the risks associated with both weight stigma and weight cycling.) It could also allow the children (some, remember, still in diapers) to create healthy relationships with food and movement, rather than seeing choices around food and movement as punishment for their size or a way to manipulate it.As they move into specific recommendations, they start with:Despite the lack of evidence for specific strategies on weight outcomes many of these strategies have clear health benefits and were components in RCTs of intensive behavioral intervention. Many strategies are endorsed by major professional or public health organizations. Therefore, pediatricians and other PHCPs can appropriately encourage families to adopt these strategies. To me this sounds a lot like throwing the concept of “evidence-based” right out the window. None of this means “these strategies are likely to lead to long-term weight loss,” but I'll bet that won't be what is conveyed to the patients and families upon whom these “strategies” are foisted. Before we move on to their recommendations around diet drugs, here is some research to contextualize these recommendations:Neumark-Sztainer et. al, 2012, Dieting and unhealthy weight control behaviors during adolescence: Associations with 10-year changes in body mass indexNone of the behaviors being used by adolescents for weight-control purposes predicted weight lossOf greater concern were the negative outcomes associated with dieting and the use of unhealthful weight-control behaviors…including eating disorders and weight gain [Note: This is not to say that there is anything wrong with higher-weight, but that there is something wrong with a supposed healthcare intervention that has significant risks, almost never works, and has the opposite of the intended effect up to 66% of the time.] Raffoul and Williams, 2021, Integrating Health at Every Size principles into adolescent careCurrent weight-focused interventions have not demonstrated any lasting impact on overall adolescent healthBEAT UK, 2020 Eating Disorders Association, Changes Needed to Government Anti-ob*sity StrategiesGovernment-sanctioned anti-ob*sity campaigns* increase the vulnerability of those at risk of developing an eating disorder* exacerbate eating disorder symptoms in those already diagnosed with an eating disorder* show little success at reducing ob*sityStrategies including changes to menus and food labels, information around ‘healthy/unhealthy' foods, and school-based weight management programs all pose a risk.Pinhas et. al. 2013, Trading health for a healthy weight: the uncharted side of healthy weights initiativesOb*sity-prevention programs that push “healthy eating” are triggering disordered eating in some children, creating sudden neuroses around food in children who never before worried about their weightThey were all affected by the idea of trying to adopt a more healthy lifestyle, in the absence of significant pre-existing notions, beliefs or concerns regarding their own weight, shape or eating habits prior to the interventionFiona Willer, Phd, AdvAPD, FHEA, MAICD, Non-Executive Board Director at Dietitians AustraliaQuoted from: health.usnews.com/health-news/blogs/eat-run/articles/for-healthy-kids-skip-the-kurbo-app“Dieting to a weight goal was found to be related to poorer dietary quality, poorer mental health and poorer quality of life when compared with people who were health conscious but not weight conscious”Ok. Moving on.RECOMMENDATION: Use of Pharmacotherapy (aka Weight Loss Drugs)Their consensus recommendation is that pediatricians and other PCHPs “may offer children ages 8 through 11 years of age with ob*sity weight loss pharmacotherapy, according to medication indications, risks, and benefits as an adjunct to health behavior and lifestyle treatment.”They admit that “For children younger than 12 years, there is insufficient evidence to provide a Key Action Statement (KAS) for use of pharmacotherapy for the sole indication of ob*sity,” but then go on to suggest that if kids 8-11 also have other health conditions, somehow weight loss drugs (which are not indicated for the treatment of the actual health conditions they have) “may be indicated.”Their KAS is that “pediatricians and other PHCPs should offer adolescents 12 y and older with ob*sity weight loss pharmacotherapy, according to medication indications, risks and benefits as and adjunct  to health behavior and lifestyle treatment.”The studies that were actually included in the evidence review predominantly studied metformin (alone and in combination with other drugs,) which is not approved for weight loss, orlistat, exenatide, and one study that looked at phentermine, mixed carotenoids, topiramate, ephedrine, and recombinant human growth hormone.Even though the studies for other drugs did not exist at the time of the evidence review, they made the choice to include them anyway. (This includes Wegovy, the drug that Novo Nordisk, a donor to the AAP, has promised their shareholders will be a blockbuster and that announced its approval in children as young as 12 just days prior to the publication of the guidelines.) Let's look at the efficacy of the drugs they are recommending:MetforminAdverse effects include bloating, nausea, flatulence, and diarrhea and lactic acidosis which they characterize as “serious but very rare.” The guidelines describe the evidence of metformin for weight loss in pediatric populations as “conflicting” They evaluated 16 studies, about two-thirds of which showed a “modest BMI reduction” and one-third showed “no benefit.” Also, this drug is not approved for weight loss. They recommend that due to the “modest and inconsistent effectiveness, metformin may be considered as an adjunct to intensive health behavior and lifestyle treatment (IHBLT) and when other indications for use of metformin are present.”Orlistat:This drug is currently approved for ages 12 and up. Orlistat is sold under the name alli by GlaxoSmithKline and as Xenical by Genentech (both GlaxoSmithKline and Genentech are donors to the AAP.) The guidelines point out that the side effects (including fecal urgency, flatulence and oily stool) “greatly limit tolerability” but do say that “Orlistat is FDA approved for long-term treatment of ob*sity in children 12 years and older.” They cite two studies from 2005. One (Behzat et al., Addition of orlistat to conventional treatment in adolescents with severe ob*sity) started with 22 adolescents, 7 of whom dropped out within the first month due to drug side effects. The remaining 15 subjects were followed for 5-15 months with an average of 11.7 months of follow up. Those 15 patients lost 6.27 +/- 5.4 kg within the study time.The other (Chanoine JP et al, 2005, Effect of orlistat on weight and body composition in ob*se adolescents) was a one-year study with 357 adolescents (age 12-15) in the Orlistat group. They lost weight initially but the weight loss stopped at week 12 and by the end of the study the weight of those in the Orlistat group had increased by .53kg.Glucagon-like peptide-1 receptor agonistsThese are drugs that are type 2 diabetes medications that were found to have a side effect of weight loss. In some cases they have been rebranded specifically for weight loss and, in others, are prescribed off-label.ExenatideThis drug is currently approved in kids ages 10 to 17 years of age. The guidelines point out that a small weight loss was shown in two small studies but with “significant adverse effects.”LiraglutideThe study they cite for liraglutide (Kelly et al, Trial Investigators. A randomized, controlled trial of liraglutide for adolescents with ob*sity.) was a 56 week study with a 26-week follow-up period. Participants lost weight initially, but after 42 weeks began to regain weight (though they were still on the drug) at 56 weeks weight gain became more rapid and at the end of the 26-week follow up they were nearing baseline. The guidelines characterize this as “A recent randomized controlled trial found liraglutide (daily injection) more effective than placebo in weight loss at 1 year among patients 12 years and older with ob*sity who did not respond to lifestyle treatment.” They do not make it clear that participants experienced near total weight regain (see graphic below.) In addition to the near total lack of weight loss (and remember that it's pretty likely that subjects continued to regain weight after the tracking stopped at 82 weeks,) side effects included nausea and vomiting, and among patients with a family history of multiple endocrine neoplasia, a slightly increased risk of medullary thyroid cancer. Liraglutide is sold as Victoza and Saxenda by Novo Nordisk. This study was a clinical trial funded by Novo Nordisk, multiple study authors work for, are employees of, take payments from and/or own stock in Novo Nordisk (see disclosures below) and Novo Nordisk provides funding directly to the American Academy of Pediatrics, and has paid thousands of dollars to authors of these guidelines.Just for funsies I checked the disclosures: Dr. Kelly reports receiving donated drugs from AstraZeneca and travel support from Novo Nordisk and serving as an unpaid consultant for Novo Nordisk, Orexigen Therapeutics, VIVUS, and WW (formerly Weight Watchers); Dr. Auerbach, being employed by and owning stock in Novo Nordisk; Dr. Barrientos-Perez, receiving advisory-board fees from Novo Nordisk; Dr. Gies, receiving advisory-board fees from Novo Nordisk; Dr. Hale, being employed by and owning stock in Novo Nordisk; Dr. Marcus, receiving consulting fees from Itrim and owning stock in Health Support Sweden; Dr. Mastrandrea, receiving grant support from AstraZeneca and Sanofi US and grant support and fees for serving on a writing group from Novo Nordisk; Ms. Prabhu, being employed by and owning stock in Novo Nordisk; and Dr. Arslanian, receiving fees for serving on a data monitoring committee from AstraZeneca, fees for serving on a data and safety monitoring board from Boehringer Ingelheim, grant support, paid to University of Pittsburgh, and advisory-board fees from Eli Lilly and Novo Nordisk, and consulting fees from Rhythm Pharmaceuticals. Melanocortin 4 receptor (MC4R) agonistsThese are specialty drugs that are only FDA approved for patients 6 years and older with proopiomelanocortin deficiency, proprotein subtilisin or kexin type 1 deficiency and leptin receptor deficiency confirmed by genetic testing. They site a small, uncontrolled study in which patients experience weight loss of 12-25% over 1 year. PhenterminePhentermine is a controlled substance chemically similar to amphetamine which carries a risk of dependence as well as side effects including elevated blood pressure, dizziness, and tremor. These are FDA approved for a 3-month course of therapy for adolescents 16 or older. I'm not clear what good could come out of giving a teenager a drug with these kinds of risk for 3 months?TopiramateThis is a drug that is used to treat seizures and migraines that happens to have a side effect of making people not want to eat through what the guidelines admit are “largely unknown mechanisms.” These drugs cause cognitive slowing and can cause embryo malformation. It's approved for children 2 years and older with epilepsy and 6 and older for headaches and I cannot for the life of me imagine how it could possibly be ethical to cause cognitive slowing in a child (who is going to school!) in order to disrupt their bodies hunger signals.Phentermine/TopiramateYou read that right, those last two drugs with the dangerous, quality-of-life impacting side effects? The guidelines discuss the option of prescribing them together. To children. This is based on a 56-week study (Kelly et al, 2022, Phentermine/topiramate for the treatment of adolescent ob*sity.) In the study, 54 subjects were given a mild dose, 15 of them dropped out. 113 were given the “top dose” 44 of them dropped out. As we've seen in other studies, weight loss had leveled off and begun to rise slightly by week 56 and there is no reason to believe it wouldn't go back up, but we'll never know because they didn't do any more follow-up. By the way, like most of the other studies, these subjects were also undergoing a “lifestyle modification program.” Also, like the other drugs, I think it's important to note that this was FDA-approved for “chronic treatment” based on the results of a study that only lasted 56 weeks. That is a common situation with weight loss drugs.Finally, the guidelines don't mention that side effects of this drug include increased heart rate, suicidal behavior and ideation, slowing of linear growth, acute myopia, secondary angle closure glaucoma, visual problems; mood and sleep disorders; cognitive impairment; metabolic acidosis; and decrease in renal function.  As I was looking this up, I noticed that the lead author of this study is the same lead author of the liraglutide study. Phentermine/Topiramate is sold under the brand name Qysmia by Vivus. I had to do some digging to get to the disclosures on this one and what do you know, Dr. Kelly has received grant consideration and consults for Vivus. In fact, with the exception of Megan Oberle, every author of this study either receives funding from/consults for Vivus, or is an employee of Vivus. Megan Oberle lists no conflicts of interest in this 2022 study but, interestingly, in a 2019 study (It is Time to Consider Glucagon-Like Peptide-1 Receptor Agonists for the Treatment of Type 2 Diabetes in Youth) the disclosure states “MO serves as site PI [principal investigator] for study through Vivus Pharmaceuticals” so we know they're not strangers. LisdexamfetamineThis is a stimulant that is approved for kids 6 and older who have ADHD, in those 18 and up for Binge Eating Disorder, and while it is sometimes prescribed off-label for higher-weight kids, the guidelines note that “no evidence available at the time of this review to demonstrate safety or efficacy for the indication of ob*sity in children.”Summing up, there are significant risks of side effects (some life threatending) and not a drug among them has shown anything approaching long-term efficacy. Let's look at the last of the recommendations.RECOMMENDATION: Weight Loss SurgeryThis is the last bit I'll write about today. This section beginsIt is widely accepted that the most severe forms of pediatric ob*sity (ie, class 2 ob*sity; BMI ≥ 35 kg/m2, or 120% of the 95th percentile for age and sex, whichever is lower) represent an “epidemic within an epidemic.”Remember, for a moment, that this phrasing is from authors who swear up and down that they are working to end weight stigma. One wonders what they would have written if they were trying to stigmatize higher-weight children. (Just fyi, if anyone is confused, you can't usefear-mongering language, describing a group of people simply existing in the world at a higher-weight as an “epidemic” without stigmatizing them.)The KAS here (for me the most horrifying of those offered,) isPediatricians and other PHCPs should offer referral for adolescents 13y and older with severe ob*sity (BMI ≥ 120% of the 95th percentile for age and sex) for evaluation for metabolic and bariatric surgery to local or regional comprehensive multidisciplinary pediatric metabolic and bariatric surgery centers. [I'll note here that at least one of the authors of these guidelines runs just such a facility.]Before we get too far into this, let's be clear about what these surgeries do. They take a child's perfectly functioning digestive system, and put it into a (typically irreversible) disease state forcing, restriction and/or malabsorption (for an explanation of the various surgeries, check out this post.) If this state happens to a child because of disease or accident, it is considered a tragedy. If the child is higher-weight, it is considered, at least by the authors of these guidelines, healthcare.They make the claim “Large contemporary and well-designed prospective observational studies have compared adolescent cohorts undergoing bariatric surgical treatment versus intensive ob*sity treatment or nonsurgical controls. These studies suggest that weight loss surgery is safe and effective for pediatric patients in comprehensive metabolic and bariatric surgery settings that have experience working with youth and their families”To support this, they cite a single study. The study (Laparoscopic Roux-en-Y gastric bypass in adolescents with severe ob*sity (AMOS): a prospective, 5-year, Swedish nationwide study) included 81 subjects who underwent Roux-en-Y gastric bypass.The average weight loss was 36·8 kg over five years, but 11% of those who had the surgery lost less than 10% of their body weight.A full 25%  had to have additional abdominal surgery for complications from the original surgery or rapid weight loss and 72% showed some type of nutritional deficiency. And that's just in five years. Remember that the damage done to the digestive system is permanent. They are recommending this as young as 13, so a five year follow-up only gets these kids to 18. Then what?By the look of their own graph, what comes next may well be more weight gain, since the surgery survivors' weight loss leveled off after year one and started to steadily climb after year two. There's also the impact of those nutrient deficiencies. They also claim that these surgeries lead to a “durable reduction of BMI.” Let's take a look at the studies they cite to prove that.Inge et al., 2018 Comparison of Surgical and Medical Therapy for Type 2 Diabetes in Severely Ob*se AdolescentsThis study lasted two years. It looked at data from 30 adolescents who had weight loss surgery. They averaged 29% weight loss over 2 years and 23% of the subjects had to have a second surgery during those two years.Göthberg et al., 2014, Laparoscopic Roux-en-Y gastric bypass in adolescents with morbid ob*sity--surgical aspects and clinical outcomeThis study just rehashes information from the Olbers study above.O'Brien et al. Laparoscopic adjustable gastric banding in severely ob*se adolescents: a randomized trialThis study is about gastric banding and I'm not sure why they included it because in the paragraph above it they point out that these surgeries are “approved by the FDA only for patients 18 years and older, have declined in use in both adults and youth because of worse long-term effects as well as higher-than expected complication rates” (they cite 18 studies to back up this particular claim.)Olbers et al., 2012 Two-year outcome of laparoscopic Roux-en-Y gastric bypass in adolescents with severe ob*sity: results from a Swedish Nationwide Study (AMOS)These are just the two-year outcomes from the five-year Olbers study aboveOlbers et al. Laparoscopic Roux-en-Y gastric bypass in adolescents with severe ob*sity (AMOS): a prospective, 5-year, Swedish nationwide study.This is the exact same 5-year Olbers study from above, just given a different citation number.Ryder et al., 2018 Factors associated with long-term weight-loss maintenance following bariatric surgery in adolescents with severe ob*sityThis study included 50 subjects who had Roux-en-Y gastric bypass and had a follow-up at year one and another follow-up sometime between years 5 and 12. They were then divided into “regainers” and “maintainers” though by their criteria, “maintainer” subjects could regain, they just couldn't regain more than 20% of the weight they lost prior to their follow-up. Though the study is called “Factors associated with long-term weight-loss maintenance” they were not able to identify any factors that were predictors of “regaining” or “maintaining.” You'll note in the graph below that weight was still trending upward when they stopped following up.So let's recap: They cite 7 studies to back up their recommendation of referrals for these surgeries for kids ages 13 and up. Four of the seven are the same study. One is a study for a surgery that they themselves have said is declining in use, so I'm excluding it. Combined, the rest of the studies followed a grand total of 161 people. The longest follow-up is “5+ years” and the studies consistently showed weight regain that was trending up when follow-up ended, as well as high rates of additional surgery and nutrient deficiencies. This, to me, doesn't come close to justifying a blanket recommendation that every kid 13 and older whose BMI ≥ 120% of the 95th percentile for age and sex be referred for evaluation for weight loss surgery.And when it comes to their criteria for these surgeries, they predicate risk on size. Those with “class 2 ob*sity” are required to have “clinically significant disease” which doesn't make the surgery ethical but, in comparison; children with “class 3 ob*sity” simply have to exist in the world to meet the criteria to have their digestive system put into a permanent disease state. One thing they do point out is that recent data showing multiple micronutrient deficiencies following metabolic and bariatric surgery serve to highlight the need for routine and long-term monitoring. Here we see a serious issue with giving this surgery to adolescents. First of all, they are rarely in control of their access to food. If their parents don't buy them what they need, if a parent loses their job and can no longer afford the supplements they require, if they experience hunger and/or homelessness… there are so many things that could impact a 13-year-old's ability to eat in the very specific ways they need to after the surgery for the rest of their life. Also, these surgeries are going to change the ways that these kids eat - at every school lunch, birthday party, family holiday. Anytime food is served, it is going to become clear that they are different, and if they aren't in charge of preparing the food, there is no guarantee that they will be able to get what they need. And that's if they want to do that. Let's not forget, these are humans who are/will be exploring their independence, including through rebellion, they are humans whose prefrontal cortex is not fully developed, meaning that they can literally lack the ability to fully recognize the consequences of their choices. (Of course, given that we only have five years of follow-up data, I would argue that their doctors and surgical teams also lack the ability to fully recognize the consequences of their choices.)The authors end the section with a fairly shameless plug for insurance coverage of these surgeries. This is another long-time goal of the weight loss industry that has made its way into these guidelines.I think this is a good time for a reminder that thin kids get the same health issues for which higher-weight kids are referred to these surgeries and thin kids are NOT asked to take the risks of these surgeries or to have their digestive systems permanently altered. They just get the ethical, evidence-based treatment for the health issue they actually have. Also, remember that the authors' research methodology specifically excluded research about weight-neutral intervention to see if any health benefits that the surgeries might create could be achieved without the significant (and, from a long-term perspective, largely unknown) risks of these surgeries, and perhaps be more lasting?But there is more to this in terms of informed consent. There are many of the same issues that we see with adults (which I wrote about here). With kids, there is another layer. In the state of California, for example, it is illegal to give a tattoo to someone under the age of 18, even with parental permission. But an eighth grader can make the decision to have their digestive system permanently altered, impacting their life and quality of life in myriad ways, many of which are unknown, and with no prognostics? Given all of this, is informed consent even possible for these kids? I would argue that it is not.Even worse, how many kids' parents, in some combination of weight stigma, concern for their child, and acquiescence to a doctor who may be pressuring them, will make this decision for their child?While I'm sure that there are adolescents who had the surgery and are happy with their outcome, I'm equally sure that there are adolescents who had terrible outcomes and would give anything to not have had the surgery (I know because I hear from them). And I know that the research can't tell us why anyone has the outcome they have. When you combine that with the total lack of long-term follow-up (I'm completely unwilling to consider 5 years “long term” for a lifelong intervention,) I think what we have here are, at best, experimental procedures, not procedures that should receive the kind of blanket recommendations that these guidelines provide for kids as young as 13.Ok, there's a lot more to discuss in these guidelines but I will save that for another newsletter. I hope that the outcry against these guidelines is loud, sustained, and successful in getting them rescinded. Kids deserve far better than this.Finally, I just want to give a quick shout-out to my paid subscribers (I know not everyone can/wants to have a paid subscription and that's totally fine - absolutely no shame at all if you are reading this for free as a subscriber or randomly!) those who are able to pay are allowed me to spend HOURS this week going through these guidelines and creating Thursday's post and this post, I'm just super grateful for the support.I'll be posting additional deep-dives into the research they cite and I'll keep a list here:“New insights about how to make an intervention in children and adolescents with metabolic syndrome” Pérez et al.Did you find this post helpful? You can subscribe for free to get future posts delivered direct to your inbox, or choose a paid subscription to support the newsletter and get special benefits! Click the Subscribe button below for details:Liked this piece? Share this piece:More research and resources:https://haeshealthsheets.com/resources/*Note on language: I use “fat” as a neutral descriptor as used by the fat activist community, I use “ob*se” and “overw*ight” to acknowledge that these are terms that were created to medicalize and pathologize fat bodies, with roots in racism and specifically anti-Blackness. Please read Sabrina Strings Fearing the Black Body – the Racial Origins of Fat Phobia and Da'Shaun Harrison Belly of the Beast: The Politics of Anti-Fatness as Anti-Blackness for more on this. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

Today we explore some different tools to break through our fears that often hold us back and how to create the life that we want. If you'd like to find out more and possibly work with margarita you can find her here. Website: margaritayagudaevpinhas.com successyogacenter.com Facebook: https://facebook.com/margarita.yagudaevpinhas https://facebook.com/successyoga Instagram: https://instagram.com/margarita_y_p https://www.instagram.com/success.yogacenter/ Youtube: https://www.youtube.com/channel/UCEt8wGSTK_6LSk7VgkPpaVA

To follow along with this study, visit: https://www.sefaria.org/sheets/419664?lang=bi Pinechas, Pinchas, Pinhas, or Pin'has (פִּינְחָס‎—Hebrew for "Phinehas," a name, the sixth word and the first distinctive word in the parashah) is the 41st weekly Torah portion (פָּרָשָׁה‎, parashah) in the annual Jewish cycle of Torah reading and the eighth in the Book of Numbers. It tells of Phinehas's killing of a couple, ending a plague, and of the daughters of Zelophehad's successful plea for land rights. It constitutes Numbers 25:10–30:1. The parashah is made up of 7,853 Hebrew letters, 1,887 Hebrew words, 168 verses, and 280 lines in a Torah scroll (סֵפֶר תּוֹרָה‎, Sefer Torah). To support Eliyahu Jian's work, visit vitaltransformation.org/donate Got a question? Click here to submit a form with your question and Eliyahu will respond to your email as soon as he can! — eliyahujian.com/contact For more than three decades, Eliyahu Jian has been guiding men and women through the process of strengthening their relationships, improving their businesses, and embracing healthier lifestyles while connecting to a higher power and purpose. Eliyahu's roles have included coaching CEOs, investment fund managers, entrepreneurs, and leaders from every walk of life. "How we feel today and every day is a choice. What will you choose to create in your life?" - Eliyahu To rediscover your spiritual path, visit eliyahujian.com/store to schedule a session OR email info@eliyahujian.com for a FREE consultation. - Healing Session - Business Coaching Session - Relationship Coaching Session - Soul Reading - Astrology Chart Session We can not do this without YOU! To join the online community, visit: vitaltransformation.org • Click here to subscribe: youtube.com/EliyahuJian/?sub_confirmation=1 • Click here to watch another video: youtube.com/EliyahuJian For important info and weekly updates, subscribe to the weekly email list by visiting eliyahujian.com , scrolling all the way down to the bottom left, and entering your email! Follow Eliyahu Jian: • Instagram: www.instagram.com/eliyahujianofficial/ • Twitter: twitter.com/eliyahujian • Facebook: www.facebook.com/EliyahuJianOfficial Follow Vital Transformation: • Instagram: www.instagram.com/vital_transformation/ • Twitter: twitter.com/TransformVital • Facebook: www.facebook.com/vitaltransformation.org Eliyahu Jian: "I don't take myself too seriously and I like to make people laugh and help them choose joy and happiness. I like to simplify spirituality and make it more accessible. I translate profound spiritual wisdom into practical, everyday advice that empowers people to live their happiest and most fulfilled experiences."

durée : 00:32:02 - Talmudiques - par : Marc-Alain Ouaknin - .Les commentateurs bibliques soulignent à quel point ce n'est pas seulement le pain qui est source de la vie, mais aussi le langage, la manière dont nous disons le monde, le choix des mots, la douceur du ton, la beauté du rythme, bref tout ce qui fait ce qu'on appelle une langue. - invités : Rosie Pinhas-Delpuech Romancière et traductrice.

Video Podcast - T2 - Treceavo Episodio Rebeca Pinhas. CSW, WSET3. California. USA. SMV Rebeca Pinhas. CSW, WSET3. Americana y Costarricense. Radicada en NOLA, que como aprendimos significa New Orleans, Luisiana. Nos contó sobre las uvas en NOLA, de como llegó al mundo del vino y en general un poco más de su persona y su gran proyecto de vino-mom-nola. La pueden encontrar en sus redes sociales en @vinomomnola. Entrevista realizada por Gabriel Salcedo, Licenciado en Comunicación y Publicista Chileno, Wine Communicator, radicado en EE. UU. "Simple, Mente, Vino" ™. Derechos Reservados. Prohibida su reproducción total o parcial para fines comerciales. San Francisco, California. MMXXI síguenos @simple_mente_vino @gabrielsalcedowines SAN FRANCISCO, CA, UNITED STATES • --- Send in a voice message: https://anchor.fm/gabrielsalcedowines/message Support this podcast: https://anchor.fm/gabrielsalcedowines/support

Parashat Pinhas begins with G-d's announcement of the reward that He would be giving Pinhas for his heroic act of killing two public sinners. As we read in the final verses of Parashat Balak, the nations of Moab and Midyan schemed to lure Beneh Yisrael to sins of immorality and idolatry by sending their women to seduce them. G-d punished Beneh Yisrael by bringing a deadly plague that killed 24,000 people. The plague ended only when Pinhas arose and killed Zimri – the leader of the tribe of Shimon – and Kozbi – a princess of Midyan – as they committed a public sinful act. G-d then informed Moshe that if not for Pinhas' zealotry, He would have annihilated all of Beneh Yisrael, and He was therefore granting Pinhas great reward. Rashi explains that this announcement was needed because the people harshly condemned Pinhas for slaying a prominent member of the nation. They looked down upon him for committing such an act of zealotry. G-d therefore affirmed that Pinhas acted correctly under these extraordinary circumstances, and would be receiving reward. Several explanations have been given for why the people initially condemned Pinhas for what he did. One approach stems from the comment of Targum Yonatan Ben Uziel (25:15) that Kozbi – the woman killed by Pinhas – was the daughter of Balak, king of Moab, who instigated this scheme. Our Sages teach us that although Balak was a bitter enemy of Beneh Yisrael, they were not to wage war against him because of his progeny – his great-granddaughter was none other than Rut, the righteous convert who joined Beneh Yisrael. Rut was the great-grandmother of King David, and was thus the matriarch of the Davidic royal dynasty, and the ancestor of Mashiah. Therefore, it was not a simple matter to kill Kozbi, a daughter of Balak. What if she was the daughter from whom Rut would descend? Killing her would mean preventing Rut from coming into the world – and thus preventing King David and Mashiah from being born! Indeed, many years earlier, back in Egypt, before Moshe killed the Egyptian taskmaster who was beating a slave, "Va'yar Ki En Ish" (Shemot 2:12) – Moshe looked around and saw "that there was no man," which Rashi explains to mean that Moshe saw that no righteous people would descend from this evil taskmaster. By the same token, before killing Kozbi, it was necessary to ensure that she was not destined to be the ancestor of Mashiah. This is why the Torah says that as Zimri and Kozbi committed their act, "Va'yar Pinhas" (25:7) – "Pinhas saw." Pinhas looked and saw that no righteous people could possibly descend from Kozbi. The Gemara in Masechet Sanhedrin (82a) teaches that if a man, Heaven forbid, has a relationship with a non-Jewish woman, then no Torah scholars will descend from him, and if he is a Kohen, he will have no descendants worthy of serving in the Bet Ha'mikdash. This is what Pinhas "saw" – he understood that Kozbi was not destined to be the ancestor of Mashiah, because righteous people could not be produced from a person guilty of this kind of act. Beneh Yisrael, however, condemned Pinhas, accusing him of essentially "killing" Mashiah. They charged that Pinhas acted recklessly, thereby destroying the nation's future. G-d therefore affirmed that Pinhas acted correctly, because Mashiah was not destined to descend from Kozbi. Moreover, G-d announced that Pinhas would be rewarded with "Beriti Shalom" – "My covenant of peace" (25:12). Targum Yonatan explains that it was here that G-d declared that Pinhas – who was the prophet Eliyahu – would live forever. As we know, Eliyahu was taken to the heavens alive, and will return to us to herald the imminent arrival of Mashiah. In response to the people's accusations, G-d declared that Pinhas will in the future be the one to announce the nation's redemption, that Mashiah would be coming to redeem Am Yisrael. Whereas the people charged that Pinhas in effect killed Mashiah – G-d proclaimed that to the contrary, Pinhas himself will arrive to inform the Jewish Nation that the time has come for Mashiah to come and bring us from exile.

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Pinhas 2022

Paracha Pinhas - Une autre façon de réparer ses fautes by Rav David Touitou

The Haftara read on Shabbat Parashat Shelah is the section in the Book of Yehoshua (chapter 2) which tells of the two spies sent by Yehoshua to the city of Yeriho shortly before Beneh Yisrael crossed the Jordan River into the Land of Israel. Just as Moshe sent spies before Beneh Yisrael were to have entered the land, now, forty years later, Yehoshua sent two spies ahead to Yeriho, the first city which Beneh Yisrael conquered after crossing into the land. Surprisingly, the two spies proceeded directly to the home of Rahab – a woman who, the Gemara explains, worked as a prostitute. Of all the places they could have gone for lodging, they chose specifically the home of this woman. No less surprising is the sudden transformation that Rahab underwent at that moment. The Midrash teaches that Rahab had worked as a prostitute for decades, and all the noblemen and dignitaries would visit her. And now, suddenly, she became righteous. When it was discovered that these two men were spies from Beneh Yisrael, she hid them, protected them, and told them of how she recognized that Hashem is the true G-d over the universe. She also pleaded with them to spare her and her family when Beneh Yisrael capture Yeriho. The spies promised Rahab that she would be saved, and she ended up joining Beneh Yisrael and even marrying their leader and prophet, Yehoshua. How could Rahab have made such a drastic transformation – from a woman working in the least dignified profession, to a status of piety whereby she was deemed a suitable match for Yehoshua? The answer is that the spies were sent on a special spiritual mission. The land of Canaan was overrun by impurity. It was inhabited by the descendants of Canaan – a grandson of Noah, who committed a despicable act with his grandfather. His descendants followed his legacy of immorality, and their society was characterized by decadence. The Kelipot (forces of impurity) were concentrated in the home of Rahab, where for decades, men would come for sinful purposes. The two spies were righteous Sadikim – identified by the Sages as Pinhas and Kaleb – and they arrived in order to eliminate these Kelipot, to prepare the land for Beneh Yisrael's entry by cleansing it of its impurity. And so they went directly to Rahab's home, where the impurity of Canaan was most concentrated. Their mission was to eliminate the impurity through their piety, by lodging in the home of such a woman without any impure thoughts or temptation. The spies' exceptional piety had a profound impact upon Rahab. When these two men entered her home, and – unlike the countless other men who had visited her over the years – they exhibited no lust or temptation, and were engaged in purely spiritual matters, this had a drastic effect. Their work to eliminate the Kelipot influenced her to the point where she became exceptionally righteous, worthy of joining the Jewish Nation and marrying Yehoshua. The verse states that upon the spies' return to Beneh Yisrael's camp, they told Yehoshua of their experiences – "Va'yesaperu Lo" (2:23). The verb S.P.R. ("tell" or "relate") can also be understood as an allusion to "Sapir" – sapphire, which produces a special shine. The spies told Yehoshua of the great "light" which they succeeded in producing, as evidenced by the impact of their visit upon Rahab. This showed that their excursion was indeed successful, and the land was now cleansed and ready for Beneh Yisrael to enter and establish the kind of sacred, G-dly society which they were to build.

¿Cómo era vivir en reinos cristianos durante la Edad Media? ¿Se vivía mejor en tierras islamicas? ¿Qué profesiones podían tener los judíos bajo las diversas administraciones? ¿Se pagaban impuestos especiales por ser judío? ¿Cómo influenciaba la teología cristiana y musulmana en las formas de vida de los judíos en sus tierras? Estas y muchas otras preguntas encontrarán respuesta en este maravilloso episodio junto el historiador Dr. Pinhas Bibelnik. A vuelo de pájaro trataremos de dar una visión general de las diferencias y las similitudes que enfrentaron las comunidades judías bajo el mundo cristiano y el musulman durante más de los 1000 años de Edad Media.

Pinhas 2021