Yevamot 64b ~ Urinary Tract Infections, and the Class That Went On For Too Long

This is the first of two posts for Yevamot 64 that we will learn on Tuesday. The second part will be published tomorrow.

יבמות סד,ב

רב גידל איעקר מפרקיה דרב הונא רבי חלבו איעקר מפרקיה דרב הונא רב ששת איעקר מפרקיה דרב הונא

Rav Gidel became sterile on account of Rav Huna's lectures, Rav Chelbo became sterile on account of Rav Huna's lectures and Rav Sheshet became sterile on account of Rav Huna's lectures...

Rav Huna had a lot to answer for.  His lectures went on, and on, and on, and on and on and on.  A couple of pages ago, on Yevamot 62b, Rashi explained the relationship between these lengthy classes and infertility:

איעקר מפרקיה דרב הונא.שהיה מאריך בדרשיו וצריכים למי רגלים ומעמידים עצמן ונעקרים כדתניא בבכורות 

Rav Huna would give a lengthy class and people needed to use the toilet. They delayed urinating, and as a result became sterile, as we learn in the tractate Bechorot

The suggestion here is that holding-it-in can lead to problems of fertility, and there is a least a theoretical reason why Rav Huna's lengthy classes had the unintended consequence of lowering the reproductive rates of his students.  There is a clear relationship between male infertility and repeated infections of the genitourinary tract. Here, for example, is  how one urology textbook opens its chapter on male genital tract infections and infertility:

Male Genital Tract Infections and Infertility. Neal, DE, Weinstein, SH. In Male Reproductive Dysfunction ed Kandeel FR. Informa Healthcare 2007

Any male GU infection such as prostatitis, urethritis or epididymo-orchitis can reduce both sperm count and the quality of the seminal fluid. OK, but what does that have to do with not urinating when you feel the urge? Well here's the thing: that not-going-when-you-need-to is not a good idea.

Delayed Micturation and UTIs

It's quite a challenge to determine scientifically the effect of holding-it-in (and hereafter referred to as delayed micturition, because it sounds nicer) on the risk of getting a urinary tract infection.  You can't very easily randomly assign one large group of healthy volunteers to urinating whenever they want, and a second to urinating only three times a day.

However, there are a couple of observational studies that may be able to tell us something about the risk of delayed micturition.  A 1968 study of 112 women with a documented UTI reported that further UTIs could be reduced by voiding  every two hours during the day (which sounds rather too good to be true). And a 1979 study from the (not-very-widely-read-but-it-really-is-a-journal) Scandinavian Journal of Urology and Nephrology reported that the frequency of UTI was significantly higher among women with three or less voidings per day compared with those who have to go four or more times per day. (Whether this is true for women outside of northern Jutland where the study was conducted remains unclear.)

So a decreased voiding frequency is associated with an increased number of infections, and urinary tract infections are associated with decreased fertility. Thus by the rule of transitive relations (or something clever like it) decreased voiding may indeed be associated in a causative way with decreased fertility.  

All this is highly speculative, and it would certainly be unusual for male sterility to directly result from delayed micturition.  But here's the weird thing: teachers are slightly more likely to suffer urinary tract infections when compared with the general population. Is that because they too, like their students, hold-it-in? (Yes, I know it didn't reach statistical significance, but the authors thought it was important to note, and so do I.)   

Kovess-Masféty, V. Do teachers have more health problems? Results from a French cross-sectional survey. BMC Public Health 20066:101;1-13

 Poor Rav Huna, talking on and on and on, while his miserable students had to sit there with their legs crossed and could likely only think of only one thing. We will give the last word to Rav Acha bar Yaakov, another hapless student of Rav Huna. 

אמר רב אחא בר יעקב שיתין סבי הוינא וכולהו איעקור מפרקיה דרב הונא לבר מאנא

Rav Acha bar Yaakov said, we were a group of sixty students, and all of us became sterile because of Rav Huna's lectures - except me (Yevamot 64b).

Students be warned.

Israel's Noble History

ISRAELI NOBEL PRIZE WINNERS FOR $200 PLEASE, ALEX

Quick. Name three Israelis who have won a Nobel Prize. Come on. You can do this. Still need a hint? Click here. See, I told you you'd know.  

OK, those were easy. How about this one.  Which Israel won a Nobel Prize for literature? Need a hint? He was awarded it in 1966 for "his profoundly characteristic narrative art with motifs from the life of the Jewish people" and his photo is shown here. Still not sure? You may have read his work on Rosh Hashanah and Yom Kippur which was translated into English as Days of Awe...Of course; it was Shai Agnon, who was born in Galicia, moved to what was then Palestine (twice) and died in Jerusalem in 1970.

As of this year there have been twelve Israeli winners of the Nobel Prize. We've noted Agnon as the single winner for literature, and (as you may have answered correctly) there have been three winners of the Nobel Peace Prize: Menachem Begin (1978), Yizhak Rabin and Shimon Peres (both in 1994). That leaves eight more prizes. In honor of Yom Ha'atzmaut, Israel's Independence Day, we will pause from our analysis of science in the Talmud and reflect on the Israeli winners of this prize, given each year (in accordance with the will of Alfred Nobel) "to those who, during the preceding year, shall have conferred the greatest benefit on mankind."

DANIEL KAHNEMAN, ECONOMICS, 2002

Following at an eight year prize-drought, Israel picked up her fifth Nobel in 2002, when Daniel Kahneman was awarded the 2002 Prize in Economics. In his biographical sketch, Kahneman credits his early days in the IDF with the first cognitive illusion he discovered.

““… after an eventful year as a platoon leader I was transferred to the Psychology branch of the Israel Defense Forces….We were looking for manifestations of the candidates’ characters… we felt…we would be able to tell who would be a good leader and who would not. But the trouble was that, in fact, we could not tell... The story was always the same: our ability to predict performance at the school was negligible...I was so impressed by the complete lack of connection between the statistical information and the compelling experience of insight that I coined a term for it: “the illusion of validity.” Almost twenty years later, this term made it into the technical literature. It was the first cognitive illusion I discovered.”

— Daniel Kahneman, Biographical sketch at Nobelprize.org

(I was about two-thirds of the way through Kahneman's recent best-seller Thinking Fast and Slow, when I left it on a flight from Tel Aviv. Please let me know if you find it.) 

CIECHANOVER AND HERSHKO, CHEMISTRY 2004

Ubiquitin-mediated Proteolysis.

In 2004 Aaron Ciechanover and Avram Hershko, both from the Technion in Haifa (together with Irwin Rose), were awarded the Nobel Prize in Chemistry for their discovery of how cells breaks down some proteins and not others. They discovered ubiquitin-mediated proteolysis, a process where an enzyme system tags unwanted proteins with many molecules of another protein called ubiquitin. The tagged proteins are then transported to the proteasome, a large multi-subunit protease complex, where they are degraded.

ROBERT AUMANN, ECONOMICS, 2005

Robert Aumann from the Hebrew University won the 2005 Nobel Prize in Economics for his work on conflict, cooperation, and game theory (yes, the same kind of game theory made famous by John Nash, portrayed in A Beautiful Mind). Aumann worked on the dynamics of arms-control negotiations, and developed a theory of repeated games in which one party has incomplete information.  The Royal Swedish Academy of Sciences noted that this theory is now "the common framework for analysis of long-run cooperation in the social science." The kippah-wearing professor opened his speech at the Nobel Prize banquet with the following words (which were met with cries of אמן from some members of the audience):

ברוך אתה ה׳ אלוקנו מלך העולם הטוב והמיטב

The four-minute video of his talk should be required viewing for every Jewish high school student (and their teachers).

ADA YONATH, CHEMISTRY, 2009

Remember ribosomes from high school? They are the machines inside all living cells that read messenger RNA and link amino acids in the right order to make proteins.  In 2009, Ada Yonath from the Weizmann Institute shared the Nobel Prize in Chemistry for her work on the structure and function of the ribosome. Specifically, she reported their three-dimensional structure and her work in the 1980s was "instrumental for obtaining the robust and well diffracting ribosome crystals that eventually led to high resolution structures of the two ribosomal subunits." Why is this important?  Well, many antibiotics target the ribosomes of bacteria, and so knowledge of how antibiotics bind to the ribosome may help in the design of new and more efficient drugs.  

Available structures of antibiotics targeting the small ribosomal subunit (30S). From Franceschi and Duffy. Structure-based drug design meets the ribosome. Biochemical Pharmacology 2006; 71; 1016-1025.

DAN SHECHTMAN, CHEMISTRY, 2011

in 1982, Shechtman was working at the US. National Institute of Standards and Technology. As he was looking through an electronic microscope at the structure of new material that he was studying, and noted that the atoms had arranged themselves "in a manner that was contrary to the laws of nature." 

אין חיה כזו – There is no such entitiy" was how he recalled responding to what he had seen. Shechtman double checked his findings and submitted them for publication; the paper was rejected immediately, not worthy even of being sent on for peer review. But Shechtman did manage to get his work published, work that the Nobel Committee found questioned a fundamental truth of science: that all crystals consist of repeating, periodic patters. Shechtman's discovery of what were later to be called quasicrystals  was important not only because of what he found. It was important that he found. Here's why:

“Over and over again in the history of science, researchers have been forced to do battle with established “truths”, which in hindsight have proven to be no more than mere assumptions. One of the fiercest critics of Dan Shechtman and his quasicrystals was Linus Pauling, himself a Nobel Laureate on two occasions. This clearly shows that even our greatest scientists are not immune to getting stuck in convention. Keeping an open mind and daring to question established knowledge may in fact be a scientist’s most important character traits.”

— The Swedish Academy of Sciences. The Nobel Prize in Chemistry 2011. Information for the Public

ARIEH WARSHEL AND MICHAEL LEVITT, CHEMISTRY 2013

Israelis continued with a winning streak at chemistry. In 2013 Arieh Warshel and Michael Levitt shared the prize in, yes, Chemistry, (together with Marin Karplus, a Jew, but not yet an Israeli). Working together in the 1970s on GOLEM, the supercomputer at the Weizmann Institute, they developed computer programs that could simulate chemical reactions with the help of quantum physics.  These programs, and their offshoots, are used in a variety ways, from optimizing solar panels to designing new drugs.

Joshua Angrist, Economics 2021

The most recent Israeli Nobel laureate is Joshua Angrist, who was awarded the 2021 Nobel Prize in Economics. Angrist, who is a professor at The Massachusetts Institute of Technology, was born in the US but lived in Israel in the 1980s, where he served as a paratrooper. He holds dual US-Israeli nationality, and has spent much of his career analyzing the economics of schooling and the effect of class size on academic achievement. One of his papers looks at the “Maimonides Rule,” named for, well, Maimonides, who apparently noted a correlation between class size and student achievement.

THE LAST WORD

There you have it. Thirteen remarkable Israelis who have contributed to peace efforts, science and literature, and whose efforts were recognized by a Nobel Prize. As we celebrate Yom Ha'atzmaut, let's give the last word to the 2005 winner Robert Aumann, who noted in his banquet speech just what is really important in life. 

“We have participated in the human enterprise – raised beautiful families. And I have participated in the realization of a 2000-year-old dream – the return of my people to Jerusalem, to its homeland.”

— Robert Aumann, Nobel Prize banquet speech, 2005.