Thursday, May 30, 2019

A child who has been abused doesn’t wear the evidence of abuse as obviously as a child who has been infected with the measles. However, anecdotes are not science, and child sexual abuse is far more prevalent and perhaps more deadly than measles.....

The Danger of a Little Knowledge – Vaccinations and Child Sexual Abuse

As measles rages through major Orthodox Jewish communities, the vaccination debate naturally follows. It is a story of personal anecdote and a presumed expertise versus the scientific method and evidence based medicine. Our ignorance on vaccination efficacy mirrors our ignorance on child sexual abuse, where evidence based scientific studies in immunology (the former) and sociology (the latter) are valued less than our own personal beliefs. The biggest irony is that those who rightfully lecture anti-vaxxers on the value of science are often similarly blind when it comes to child sexual abuse. While many like to blame prominent Rabbis, the fault doesn’t truly lie with them. Rabbis can be blamed for not leading, but much of the fault lies within our own culture.

In fact, this blog post was inspired by reading online debate about vaccination, and noting how similar it was to debate on abuse (including some outspoken abuse defenders mocking anti-vaxxers for being unscientific). Of course, people rarely feel their own position is extreme. Nobody call themselves “abuse-defenders” or “anti-vaxx”.  They try to minimize and gaslight their own positions. Those who oppose vaccination don’t say things like, “Vaccines are poison, a conspiracy, and don’t work”.  Rather, they say:
I’m not anti-vaccination. I just feel there are some vaccines that my child doesn’t need, and I have questions I feel haven’t been legitimately answered.

I’m not anti-vaccination. I just know someone whose kid got autism and I just don’t know if there’s a link, so I want to be careful and follow my own schedule.

I’m not anti-vaccination. But I know what’s best for my own kid and don’t like the government telling me what to do.
Likewise, nobody says, “I love child molesters and think they should be protected.”  Rather they say:
Nobody is more anti-child molester than me! But you have to understand that in this case the allegations aren’t even sexual, and besides, they were all from a misunderstanding that took place 20 years ago. Maybe it was a bit inappropriate but not illegal. I need 100% proof.

I totally think child molesters belong in jail, but since this alleged abuser is not in jail, we have to trust him/her with our kids.  Besides, I know the alleged abuser personally and he/she would never do such a thing! He has done so much good.

I am totally against child abusers. But you have to understand that there is bad blood with this kid and she is a constant trouble maker. And the alleged abuser has kids to marry off. Since we aren’t sure, let’s just keep an eye on him
Am I making a false equivalency? I don’t think so because the same erroneous thinking and pattern of positional gaslighting underpins both arguments.

If you think this post doesn’t apply to you because you vaccinate, ask yourself why you trust the scientific method on measles, but not on child sexual abuse protection. For those who do believe in vaccination but not child safety, ask yourself why?

If we treated measles the way we treat child sexual abuse, here is what we’d say:
  • Teach your kids to be careful around those who have the measles.
  • Tell your kids to learn how not to get infected when they are near measles
  • Request those who get the measles to daven at a different shul where people don’t know they are sick.
  • When someone gets the measles, make sure to point out that he or she went 30 years without getting the measles.
  • Have the Rabbis keep an eye on people with measles to make sure they don’t cough.
  • Assign a shomer so the person with measles can attend community events with the unvaccinated.
  • Tell the child he or she does not really have measles at all, but just a rash, and that they are being reactionary to believe their doctor.
It is impossible to argue with someone when you don’t have a common basis for truth. To enter any argument, we must agree on the validity of the scientific method. Sadly, speakers at frum events on child safety and vaccination often offer tiny morsels of information to their audience. Those dispensing poor advise often have titles like PhD, MD and LCSW, impressing the audience. This leads to the listeners learning “a little bit of knowledge”, and confidently make poor choices for their

The scientific method is a way of thinking, a process where we ask questions, form a hypothesis, test that hypothesis, analyze the results, share the results, and most importantly, continue to study and analyze. Scientific studies are designed to test the success (or failure) of everything from medicine to social programs. They are shared with colleagues for critical review that feeds into new questions and new tests. Evidence based medicine is our term for learning from science, constantly reviewing and questioning our results. It is a continuous process of questioning core ideas and challenging their truth, an idea which can be foreign to any fundamentalist worldview.
In the study of vaccination or immunology, new vaccines can only be declared successful after large studies with thousands of people. There is a closed loop process, where failures are analyzed for root cause and success is constantly questioned to be sure it is real. Scientists know that even success needs to be studied.

To borrow from the Simpsons, there are no tigers in my backyard, but I don’t attribute that to my magic tiger repelling rock. However, there are also few mosquitoes in my backyard which I attribute to my work to reduce standing water. Thanks to science, I can tell you that a lack of mosquitoes is due to my own action, and a lack of tigers is not. While those who oppose vaccination try to insinuate scientists are blind to the natural decline in polio and measles, in fact, proper scientific method means even questioning success.  Studies must test a hypothesis, reduce biases, and most importantly must be repeatable and open to the scrutiny of peer review.

As an activist for child safety in our schools, camps, and synagogues, the same thinking must apply to sociology. When a recent homegrown child safety program came to town, I asked a Rabbi why he was sponsoring it. The answer was an anecdote – that he heard from someone else that it was a good program. I proceeded to follow the chain of “heard from someone else”, and quickly found that just like “vaccines cause autism”, nobody could point to the person who actually studied and approved the program. Everybody just assumed it was effective (and not harmful) because everybody else assumed it was effective (and not harmful).

I figured the person who invented the program might be of some help, so I asked the presenter directly. This person who travels the world peddling a program not only failed to point to scientific studies and peer review, but refused to share the materials at all. Evidence based medicine only works when the evidence is open for peer review. The same goes for sociological problems in our schools and synagogues.  Is it possible this community program only worked to stop child abuse in the same way that a rock can keep tigers away? The organizers would show me no test or study to see if the program actually had a positive impact.

The scientific method is not about test tubes and beakers but solving problems in the real world. You can analyze the base rate of measles in a population before and after a vaccination program to see if it works. In the same way, you can find other metrics in a school setting to see if a proposed program works to reduce child abuse. When a vaccine fails or causes injury, millions of dollars are spent to analyze why and prevent it in the future. What happens when an institution using a homegrown child safety program has a failure? Those millions aren’t spent analyzing the failure, but often on PR and lawyers to protect the institution, and sometimes even the abuser.

If you are going to invite one of the Jewish community safety organizations to your school, ask them about independent research such as that published by Darkness To Light.  You wouldn’t put a syringe in your child full of medicine that wasn’t tested, so why trust your child’s safety to programs that aren’t published and haven’t stood up to scientific scrutiny?

The same community failure occurs when we doubt the stories of abuse survivors, based on our affinity for the abuser or the abuser’s institution. While it can be easy for those not versed in clinical practice and the study of forensic interviews to say, “It’s the kid’s word against the adult”, those who work in the field of child sexual abuse understand child disclosure. A forensic interview is a controlled process to document a report of abuse. Our Rabbis and Principals are not trained to provide these interviews, and abuse policies that require a school director or synagogue Rabbi to evaluate if a claim should be reported to police risk contaminating future investigations.

It should be no surprise that the same Rabbinic Authorities that declare child abuse must be reported first to the School Principal/Rabbi are also the ones on the forefront of questioning the efficacy of vaccines. Many of the communities that are in the news today with measles outbreaks were in the news yesterday with child abuse cover-ups.

But ask yourself – if you believe strongly in the importance of vaccination and deride those who question it, are you committing the same logical errors on child abuse? Relying on lack of police action to defend inaction on child abuse is potentially just as negligent as permitting religious exemptions for non vaccination. In both cases, the law is being followed to its bare minimum, disregarding the value of public health and possibly putting children at risk. While it is true that most states provide “religious exemptions” for not vaccinating in public schools, our private schools (which are supposed to teach us our religion) should not be allowing them! Are they breaking the law? No. Are they putting our children at risk? In my opinion, yes. Our private schools should not have religious exemptions for vaccination.

And oddly enough, statements from clerical leadership use platitudes that could be copy/pasted between vaccination and child abuse. These are not exact quotes but amalgamations of statements I have read on both vaccination and child safety:
  • This is an issue of great concern to us, but we don’t want to do anything unless we are 100% sure.
  • There haven’t been enough studies to prove what you are saying.
  • We oppose people who believe/act this way, but it is very rare in our communities.
  • We are doing fantastically effective things to reduce this rare problem.
  • Those who say we aren’t doing a good job are just anti-Semites who are making the non-existent problem worse.
The truth is, we see more action on vaccination than on child abuse because when it comes to measles, it is harder to shut our collective eyes. A child who has been abused doesn’t wear the evidence of abuse as obviously as a child who has been infected with the measles. However, anecdotes are not science, and child sexual abuse is far more prevalent and perhaps more deadly than measles. It is time our community honor evidence based medicine and the scientific method, and apply it with the same care in all matters to keep our children safe.