(2005/5765)

This week we shall conclude our discussion of consuming medicines that contain Chametz or other forbidden ingredients as well as some other related issues.  The previous three sections are available at www.koltorah.org.

Homeopathic Medications

Homeopathic medicines very often contain forbidden items, including such exotic items like snake venom and dog’s saliva.  They are, however, diluted in extreme quantities, sometimes even up to one million parts.  The question is whether one violates the prohibition of Ein Mevatlin Issur Lichatchila (deliberately nullifying a forbidden item) in such a circumstance.  We are not only forbidden from nullifying a prohibited item, but we are also forbidden from benefiting from an item that was nullified on our behalf (Shulchan Aruch Y.D. 99:5).  Rav Akiva Eiger (ad. loc. s.v. V’chein; but see Taz ad. loc. 99:10) writes that this applies even if a merchant nullifies a forbidden item for anyone who will purchase this item from him and not necessarily for a specific customer. 

However, there are at least two potential reasons to be lenient regarding homeopathic medicines.  First, the Halacha might differ if the nullification was done by a non-Jew to benefit all of his customers, Jew and non-Jew alike (see Be’er Heitev Y.D. 108:7 and Darkei Teshuvah ad. loc. 20 for a review of the debate regarding this issue).  Second, Rav Chaim David Halevi (who served as the Sephardic chief rabbi of Tel Aviv for many years in the late twentieth century) argues (Techumin 3:68-69) that this prohibition does not apply since the intention of the dilution is not to nullify the prohibited substance, but rather to  prepare the elixir in the appropriate manner. 

The concern for Chatichah Atzmah Na’aseit Nevei’lah ( defined at length in last week’s essay) might be relevant, though, even though some dilutions that occur in the course of preparing homeopathic medicines occur in proportions of a hundred to one.  Nonetheless, some dilutions occur only in successive dilutions of ten to one.  However, in such a case one might rely on the  Rama cited last week who rules that in case of great need one may rely on the opinions that the principle Chatichah Atzmah Na’aseit Nevei’lah applies only to mixtures of milk and meat, in case of a Lach Bilach mixture (for further explanation, please see last week’s essay).

However, one might object to using homeopathic remedies based on the Rama (Y.D. 155:3) who writes that forbidden foods may be given to a sick individual for curative purposes only with the direction of an expert or if consuming the forbidden food is regarded as a “known” remedy (Refu’ah Yedu’ah).  The Mishnah Berurah (328:5) similarly rules that one may desecrate Shabbat to save a life only if the remedy that is being used is performed based on the direction of an expert or if it is a Refuah Bedukah.  Rav Chaim David Halevi (Techumin 3:71) cites an anonymous Rav who ruled that homeopathic remedies that contain non-kosher ingredients are forbidden since they do not constitute a Refuah Yeduah.  However, Rav Halevi disagrees and regards homeopathic medicine as a Refuah Yeduah even though many physicians trained in Western medicine see no value in them.  Rav Dovid Heber (a rabbinic coordinator at the Star-K Kashrut Agency, a renown expert in the field of the kashrut statuts of various medicines) reports that Rav Moshe Heinemann (the rabbinic administrator of the Star-K who is a leading Halachic authority) agrees and rules that as long as a recognized expert asserts the medical efficacy of a product, one may take it (if there are no  risks to one’s health) even though it contains non-kosher ingredients that are either nullified or Eino Ra’ui Laachilat Kelev.  Rav Heber adds that the Rabbanim should not endorse the  efficacy of  homeopathic products.  Rather, they should merely decide whether one is permitted to take homeopathic medicines despite their non-kosher ingredients.  The decision to take these products remains the responsibility of those who consume these products, and they should consult with recognized and competent health care providers for guidance. 

Medicine on Fast Days

Rav Moshe Feinstein (Teshuvot Igrot Moshe O.C. 3:91) rules that a Choleh She’ein Bo Sakanah (one who is ill but his life is not endangered) may take a pill if he takes it without water.  Rav Moshe explains that this is considered to be consuming a product in an unusual manner, which  a Choleh She’ein Bo Sakanah is permitted to do.  The practical problem with this, though, is that many people find it impossible to swallow a pill without water.  Rav Heber (in the tape available from the Star-K) reports that many Rabbanim commonly advise that in such a situation one should swallow the medicine with a poor tasting liquid, so that the liquid is also considered drinking in an unusual manner, which is permitted for a Choleh She’ein Bo Sakanah.  I heard that one Rav suggests putting bitter-tasting echinacea in water to use as the bitter drink (one should consult with a health care professional to determine if it is advisable to consume echinacea on a fast day).

Reciting a Bracha on Pleasant Tasting Medicine

The Shulchan Aruch (O. C. 204:8) rules that one should recite a Bracha on “any food or drink that one consumes for healing purposes if it has a good taste and is pleasant to the palate.”  Accordingly, it would seem that one should recite a Bracha on pleasant-tasting medicine.  However, applying this Halacha to modern medicines is not a simple matter.  Rav Shlomo Zalman Auerbach originally ruled (cited in Nishmat Avraham 1:91 and Shmirat Shabbat Kehilchata 40 footnote 191) that one should recite a Bracha on pleasant tasting medicine.  In addition, Dr. Abraham S. Abraham reports (Nishmat Avraham ad. loc.) that Rav Ovadia Yosef told him that he agrees with this ruling.

However, Rav Yehoshua Neuwirth (ad. loc.) disagrees arguing that since the active ingredient of the medicine is bitter, one does not recite a Bracha on the sweet inactive ingredient (the active ingredient of medicine is the ingredient that effects the cure; inactive ingredients are added to assist in the consumption of the medicine).  He argues that the sweet inactive ingredient is considered Tafel (insignificant) and thus does not merit a Bracha.  He cites the Gemara (Brachot 35b-36a) as proof to his position.  This Gemara states that one who drinks pure olive oil to cure a sore throat does not recite a Bracha because the olive oil “damages” him (even though it effects a cure) and is not considered to constitute an act of eating (see Rashi s.v. Azukei).  However, if one places the olive oil in a vegetable soup (apparently this was  a common practice in the time of the Gemara) he recites Borei Pri Haetz on the mixture since the active ingredient (the olive oil) is considered the primary and significant ingredient.  Ordinarily, though, one who places olive oil in vegetable soup and drinks it for non-healing purposes recites Borei Pri Ha’adama, since the vegetable soup is the primary ingredient (see, though, Shulchan Aruch Orach Chaim 205 for further discussion regarding whether to recite Borei P’ri Ha’adamah or She’hakol on vegetable soups).

Accordingly, Rav Neuwirth argues that  this passage in the Gemara teaches that when medicine is mixed with another product (to make taking the medicine easier) the medicine is considered the primary ingredient that determines which Bracha should be recited.  Thus, when the active ingredient (the “medicine”) is bitter (and merits no Bracha) and is mixed with pleasant tasting inactive ingredients (which do merit a Bracha), the active ingredient should be considered the primary ingredient and thus no Bracha should be recited on the elixir.  Thus, just as in the Gemara’s case, the active ingredient determines which Bracha should be recited, so too, the active ingredient determines whether a Bracha should be recited altogether on the mixture.  Rav Shlomo Zalman replies, though, that the Gemara (Berachot 35a) writes that one who benefits from this world without reciting a Bracha is compared to a thief (as he takes from Hashem without paying “the fee,” i.e. reciting the Bracha).

One could reply that the active ingredient characterizes the elixir as a medicine and not as a food.  The prohibition to benefit from this world applies only to benefiting from food without reciting a Bracha.  Medicine, simply put, is not food.  In addition, one could argue that the Halacha requires a Bracha on “medicine” only when one  consumes food or drink for healing purposes.  However, modern medicines are, generally speaking, not considered food or drink, as no one other than a sick individual would take such food, unlike the olive oil that is discussed on the Gemara.  Accordingly, Dr. Abraham (Nishmat Avraham 4:7) reports that Rav Shlomo Zalman retracted his ruling and agreed with his student Rav Neuwirth that no Bracha should be recited on pleasant-tasting medicines.  However, Rav Shlomo Zalman is cited (ad. loc.) as nonetheless ruling that a Bracha should be recited if the medicine is coated with sugar, since one tastes the sugar before taking the medicine.  Rav Heber reports that the common practice appears to accord with Rav Neuwirth’s ruling.

Dr. Abraham cites (ad. loc. 1:91) that Rav Waldenberg told him that one can avoid this controversy simply by reciting the very brief Tefillah mentioned in the Shulchan Aruch (O.C. 230:4) that one should recite before one undergoes a medical procedure.  Rav Waldenburg  argues that this recitation functions in a similar manner to a Bracha and therefore obviates the problem of stealing from Hashem, as one enjoys the sweetener only after he has thanked Hashem. 

Conclusion

I hope that our discussion of medicines and Halacha have informed and enabled our readers to competently pose questions to their Rav.  The issues are varied and are subject to change and thus one should remain informed and alert regarding the points we have outlined.

I would add that it would seem that  a potentially ideal remedy to the problem of Chametz or non-kosher ingredients in medicines is using Israeli-produced medicines that are certified  kosher.  One not only enhances his standards of Kashrut thereby, but he has also helped the business of another Yehudi (Memkar Laamitecha, see Rashi to Vayikra 25:14) and Yishuv Eretz Yisrael by facilitating Jews being able to earn a livelihood and thereby residing in Eretz Yisrael.