In last week’s essay (available at www.koltorah.org) we introduced the issue of consuming medicines that contain non-kosher ingredients and/or Chametz. We noted that, essentially, one whose life is endangered should take no chances in this regard. The more complex challenge is in regard to a sick individual whose life is not endangered. We saw that most opinions (including Rav Moshe Feinstein and Rav Ovadia Yosef) permit one to take medicine that is not fit for canine consumption, although Poskim debate how to define this category. We also quoted Rav Shlomo Zalman Auerbach who permitted one to swallow medicine that contains non-kosher ingredients or Chametz.
According to Rav Shlomo Zalman Auerbach’s ruling, one should take a medicine that is in pill form rather than chewable form. In addition, it is important to note that Rav Shlomo Zalman might even permit swallowing pills that taste good (coated tablets, for example, though perhaps he would not rely upon this regarding Pesach). Moreover, Rav Shlomo Zalman permits owning pills that contain Chametz, even though he is not certain that the Chametz contained in the pills are classified as Nifsal Meiachilat Kelev. This seems to be based on Shulchan Aruch Orach Chaim 442:4 (also see Mishnah Berurah 442:19; but see Chazon Ish ad. loc.). Teshuvot Chavalim Beneimim 5:4 (authored by Rav Yehuda Leib Graubart who lived in Toronto in the early twentieth century) explicitly states (and cites other Acharonim who agree) that one does not violate the prohibition to own Chametz with medicine pills.
According to the standards of Rav Moshe Feinstein and Rav Ovadia Yosef (as presented in the Mesorah article that we cited last week), one would be permitted to take a chewable medicine lozenge that does not taste good or has no taste. However, Rav Shlomo Zalman would not be lenient. Thus, if one’s Rav permits one to take Lactaid pills on Pesach (they reportedly contain Chametz, but appear to be tasteless) it seems to be preferable to swallow them with water rather than chew them, in order to accommodate Rav Shlomo Zalman’s opinion. One should consult his Rav for guidance regarding this issue, particularly since lactose intolerance may be classified only as a Meichush Bialma, a category that we will discuss shortly).
We should note that the question of classifying medicine tablets as Eino Ra’ui Laachilat Kelev seems to depend to a great extent on an assertion of the Chavat Daat (Y.D. 103:1, in the Bi’urim). He asserts that when a bitter tasting item has been added to a food, it is not considered to be Nifsal Meiachilat Kelev. Rather, one who eats such an item is considered to have consumed the food in an unusual manner, which is permitted for a sick person, but perhaps not for someone who is suffering from a mere Meichush as we shall explain in the next section. Based on this Chavat Daat, Rav Heber (Mesorah 14:92-93) argues that medicine tablets are not considered Nifsal Mei’achilat Kelev. However, Rav Yoezer Ariel (a prominent Israeli Dayan) writes (Techumin 15:356) that the Chavat Daat applies only when the bitter addition to the food is easily removable. Since this is not the case with medicine tablets, Rav Ariel rules that it is considered Nifsal Meiachilat Kelev.
It is important to note that pleasant tasting chewable tablets, lozenges and liquid medicine that contain non-kosher ingredients seem to be forbidden even according to both Rav Moshe and Rav Ovadia Yosef (see Teshuvot Minchat Yitzchak 9:79). Rav Heber, though, notes (Mesorah 14:92) notes that many of these medicines have a bitter aftertaste and might still be considered either not eating in the normal manner or Nifsal Meiachilat Kelev. He concludes that this is a judgment call that is left to the discretion of each Rav to decide. Perhaps, though, there is a way to be lenient regarding children and a possible solution for adults, as we shall discuss in the coming weeks (IY”H and B”N).
The Shulchan Aruch (O.C. 328) permits only a Choleh She’ein Bo Sakanah to take medicine on Shabbat. One who suffers from what is regarded as a Meichush Bialma (minor discomfort) is not permitted to take medicine on Shabbat (as part of the rabbinic prohibition to take medicine on Shabbat lest one come to grind the medicine, that we outline in essays that are available at www.koltorah.org). The Shulchan Aruch, though, in the context of taking forbidden food for medicinal purposes (Y.D. 155:3) does not state that one who is suffering only from a Meichush is not permitted to take advantage of the Shelo Kiderech Hana’ato leniency. Thus, the Chochmat Adam (Binat Adam 52) and Rav Shlomo Zalman Auerbach (ad. loc. and Nishmat Avraham 2:54) raise the possibility that even one who suffers a Meichush may consume medicine that contains forbidden foods Shelo Kiderech Hana’ato. Although the Chochmat Adam and Rav Shlomo Zalman conclude that they are uncertain about this matter (and Teshuvot Zera Emet Y.D. 48 rules strictly about this matter), the Chochmat Adam understands the Shach (Y.D. 155:13) as permitting even one who suffers from just a Meichush to consume forbidden food Shelo Kiderech Hana’ato for healing purposes.
Rav David Heber stated (on a tape that is available from the Star-K) that most Rabbanim follow the lenient approach to this matter (regarding Chametz, though, they might be more strict). Common practice also seems to follow the lenient approach to this question. For example, observant Jews take Advil even for a minor headache even though Rav Heber reports that Advil contains ingredients that might not be kosher.
Perhaps the reason for this lenient practice is the fact that one is almost always only at risk of violating a rabbinic prohibition when taking medicine, since we generally take medicine in small doses. An introduction to the topic of Chatzi Shiur (consuming less than the minimum amount) is necessary to understand this suggestion.
In general, one is not punished for consuming a forbidden item unless he eats a minimum amount (a Shiur) of that item. Thus, Beit Din will not administer Malkot (lashes) to someone who ate pig unless he consumed at least a Kezayit (reported as equivalent to 1.1 ounces according to Rav Moshe) of this forbidden animal. Similarly, Beit Din will not punish one for drinking wine used for idolatrous purposes unless he drinks at least a Revi’it (reported as 3.3 fluid ounces according to Rav Moshe). Nevertheless, it is forbidden to consume less than a Shiur of the forbidden item (Chatzi Shiur). Rav Yochanan and Reish Lakish argue (Yoma 73b) whether Chatzi Shiur is a biblical or a rabbinic prohibition. The opinion of Rav Yochanan that Chatzi Shiur constitutes a biblical prohibition is the accepted opinion (Rambam Hilchot Shvitat Asor 2:3).
However, Rav Eliezer Waldenberg (Teshuvot Tzitz Eliezer 6:16) cites the Minchat Kohen (Shaar Hataarovet 1:4) and Pri Chadash (O.C. 442) who rule that a Chatzi Shiur constitutes only a rabbinic prohibition when a forbidden food is mixed with permitted food and the permitted food is in the majority (and the mixture is smaller than the Shiur). Accordingly, Rav Waldenberg rules that taking medicine that contains forbidden foods potentially constitutes only a rabbinic prohibition since one usually takes doses of no larger than a teaspoon or a tablespoon. Thus, it is understandable why the common practice is that even one who is suffering only from a Meichush is permitted to swallow poor tasting or tasteless medicine that contains non-kosher ingredients. Since only a rabbinical prohibition is involved, we rely on the Chochmat Adam’s understanding of the Shach (though regarding Chametz we might be stricter, as we have stated).
Another possible reason to be lenient in certain cases is the fact that we often are not sure if the potentially forbidden ingredients are indeed forbidden, as Rav Heber writes in Mesorah (7:95). For example, we mentioned in an essay printed before Pesach that it is often impossible for even the manufacturer of a medicine to determine if the alcohol in a medicine is made from grain or is simply synthetic alcohol. Similarly, Rav Heber reports (on the tape available from the Star-K) that it is usually impossible to determine if the glycerin in a product is made from a forbidden animal, coconuts or petroleum. Rav Heber reports that he visited a factory that makes glycerin and he observed that even the drums in the factory do not state the origin of the glycerin. Finally, Rav Heber writes (Mesorah 14:92) that many possible non-kosher ingredients such as magnesium stearate might be Batel Bishishim (nullified in sixty parts, i.e. they constitute less than 1.6% of the volume of the product).
In addition, it is debatable whether consuming some ingredients such as lactase and gelatin is forbidden. Lactose (a sugar molecule that is predominantly found in cheese and is commercially used as a product from the cheese production process) is not included in the prohibition to consume Gevinat Akum (cheese produced by Nochrim) according to Rav Moshe (Teshuvot Igrot Moshe Y.D. 3:17; also see the essays on this topic that are available at www.koltorah.org). Gelatin is permitted by Rav Zvi Pesach Frank and is regarded by Rav Moshe (Teshuvot Igrot Moshe Y.D. 2:32) as only possibly forbidden, as we explain in an article on gelatin that is also available at www.koltorah.org.
Accordingly, there seems to be sufficient basis to permit even one who is suffering from only a Meichush to swallow a bitter or tasteless pill that seems to contain forbidden food, if an unquestionably permitted product is not available. Indeed, Rav Ovadia Yosef in Teshuvot Yechave Da’at (ad. loc.) rules that on Pesach only a Choleh (even She’ein Bo Sakanah) may take either bitter or tasteless medicine that seems to contain Chametz. He writes that one who suffers from only a Meichush is not permitted to consume such medicine. However, in Yalkut Yosef (Kitzur Shulchan Aruch p. 586 in the 5760 edition, published about twenty years after the publication of Teshuvot Yechave Da’at) Rav Ovadia is cited as permitting either bitter or tasteless medicine even for one who suffers only from a headache, even if the medicine might contain Chametz (Rav Ovadia occasionally changes his mind, as is known by those who closely follow his rulings). Nonetheless, Rav Ovadia forbids pleasant tasting chewable and/or liquid medicines and vitamins if they possibly contain Chametz (as does Rav Heber in the aforementioned Mesorah article).
Many pleasant tasting medicines contain no Chametz but contain Kitniyot such as corn syrup, which Ashkenazim customarily avoid on Pesach. The Mishnah Berurah (453:7; also see my Gray Matter 1:243) permits even a Choleh She’ein Bo Sakanah to consume Kitniyot for medical purposes, if there is no viable alternative to the Kitniyot product. It is not clear, however, if medicines with Kitniyot ingredients are permitted to one who is suffering from a mere Meichush. We should also note that Kitniyot are nullified in a mixture if the permitted food is in the majority. One should consult his Rav for a ruling regarding this matter.
Next week, Im Yirtzeh Hashem and Bli Neder, we shall continue our discussion of medicine that contains non-kosher ingredients. We shall discuss a possible basis to permit giving pleasant tasting liquid or chewable medications to children, an interesting possible manner to render pleasant tasting cough medicine that contains glycerin as permissible, taking medicine on a fast day and the question of reciting a Bracha on medicines.