Science

Controversial pedophile study finds drug may reduce risk of child sexual abuse

Controversial pedophile study ...
A study found a drug may rapidly reduce pedophilic desire within days of treatment
A study found a drug may rapidly reduce pedophilic desire within days of treatment
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A study found a drug may rapidly reduce pedophilic desire within days of treatment
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A study found a drug may rapidly reduce pedophilic desire within days of treatment

Four years after it was first announced, the results of a controversial clinical trial have finally been published in the journal JAMA Psychiatry. The study found a testosterone-reducing drug, originally developed as a prostate cancer treatment, lowered sexual interest in children for men with pedophilic disorder.

The unique clinical trial initially made headlines in 2016 when its research team, from the Karolinska Institutet and Gothenburg University in Sweden, turned to crowdfunding after it fell short of its funding goals. The trial set out to offer the first ever randomized, double-blind, placebo-controlled investigation into the efficacy of chemical castration for men with sexual attraction to children.

Chemical castration, an umbrella-term referring to drug treatments designed to lower sex drive and desire, has long been a controversial method for treating convicted pedophiles. In several parts of the world the treatment is forced upon convicted sex offenders, while other places offer the therapy on a voluntary basis for convicted men in prison.

Alongside any ethical considerations, the efficacy of chemical castration as a method to control pedophilic impulses is still yet to be clearly demonstrated. All uses of the method so far have been limited to correctional facilities, and lower rates of recidivism when subjects have been subsequently released are often pointed to as examples of a self-fulfilling prophecy – the men most compelled to undergo the treatment may be the least likely to reoffend.

The only way to eliminate these questions over efficacy would be through a rigorous clinical trial. Of course, there is absolutely no ethical body in the world that would approve giving placebos to men convicted of child sexual abuse and then releasing them into a community as a control group to compare their results against an active drug group. So a team of researchers in Sweden came up with a fascinating way around this ethical dilemma.

In Sweden there is a national telephone help line for individuals with unwanted sexual thoughts called PrevenTell. The goal of the helpline is to prevent sexual abuse or violence before it occurs by offering specialist help to those with problem behaviors. Through the helpline, the researchers recruited 52 men with self-confessed pedophilic disorder. On their initial visit to the hospital for baseline evaluation, the men were administered either a placebo or a drug called degarelix.

Degarelix is a gonadotropin-releasing hormone antagonist first approved for human use as a prostate cancer treatment a little over a decade ago. Because the drug is known to swiftly decrease testosterone levels to almost zero in a matter of days, it was hypothesized as being potentially useful in this context as a way to rapidly reduce acute pedophilic urges.

The primary efficacy outcome in the trial was measured by calculating a composite risk score. The score measured self-rated risk plus four other empirically derived factors: pedophilic disorder, sexual preoccupation, impaired self-regulation, and low empathy. Participants were scored at baseline, two weeks after treatment, and then again 10 weeks later.

The researchers report a statistically significant decrease in the composite risk score of the degarelix group compared to placebo at both the two-week and 10-week follow up. Two of the subjects in the degarelix group suffered from episodes of suicide ideation, noted as the primary adverse affect of the treatment.

“It’s important to be able to offer a relatively fast-acting treatment, and the patients’ own experiences of the drug were overall positive,” says lead on the study, Christoffer Rahm. “This study is an important step towards an evidence-based treatment for pedophilic disorder.”

Questions have been raised, however, over some broad generalizations made in the research. In an interview with The Guardian, Michelle Degli Esposti from the University of Oxford suggests it is unclear whether the treatment would actually reduce real-world occurrences of child sex abuse, as the men in the study are all self-selected and actively reaching out for assistance.

Armon Tamatea, clinical psychologist and president of the Australian & New Zealand Association for the Treatment of Sexual Abuse, also questions whether a sample cohort such as this can be representative in regards to actively reducing acts of child sexual abuse in real-world scenarios.

“The sample was (1) drawn from the community, and the majority (85% for each group) did not have prior contact with a criminal justice agency, (2) were self-referrers who were anxious about their ‘self-identified unwanted sexuality’, so presumably not currently engaged in counseling or treatment of some kind to address these issues, and (3) were clearly distressed by their ‘condition’, hence their motivation to contact the researchers,” Tamatea writes in an email to New Atlas. “Much child abuse occurs within the home and under a code of silence. Men who have come to the attention of the criminal justice system for child sex offences do so because of victim disclosures, or may self-disclose when a court case is immanent in order to access community-based treatment and hopefully avoid a full prison sentence.”

Alongside questions over the real-world veracity of the study, longstanding ethical debates have been rekindled over the medicalization of pedophilic disorders.

“Should we be focusing on medicating individuals who have sexual desire for children and, if so, do we expect these individuals to take drugs that have known side-effects? Or should we instead be focusing on tackling the upstream societal and structural factors that place children at risk of being sexually abused?” asks Degli Esposti, who did not work on this study. “It may not be a question of either/or, and such questions go beyond the findings of this specific study, but it is important to consider the implications of medicalizing profound societal problems such as child sexual abuse.”

Tamatea also points out the utility of medical treatment for these kinds of conditions is limited without broader psychological treatments and interventions. He suggests the cause, course and cessation of sexually harmful behavior cannot be sufficiently explained by biological influences alone.

“Ethically, framing what are really psychological and social problems through a medical lens will miss critical psychological, social, and even environmental factors that contribute to harmful sexual behavior,” writes Tamatea. “Furthermore, relying on biological treatments circumvents important issues like insight and responsibility that are central to assist people to address these kinds of issues – and may perpetuate further harm because the behavior is seen as a medical problem rather than one of poor self-management and seeking opportunities for inappropriate sexual gratification.”

The new study was published in the journal JAMA Psychiatry.

Source: Karolinska Institutet

4 comments
Karmudjun
Armon Tamatea is absolutely correct in nearly every one of the points he raised - with the last first - This is an issue of insight and responsibility toward one's sexuality & societal norms. If children are to be manipulated for your own gratification and society agrees, such as when you focus your child on playing piano every day of their childhood from the time they could reach a keyboard - you are a great person and maybe called a "Tiger Mom" or "Tiger Parent". SInce society has changed from the ancient tribal days of Rome & Greece when we have records of the first adult-child sexual relationships (that I know of anyway), defining the proper age of consensual sexual partnership is societal and those who offend disregard that norm. I do not think a group of men and/or women who are grappling with feelings outside of societal norms are representative of the offenders. We incarcerate those who offend, who commit acts that the rest of us - if we could or would think them - generally disregard as bizarre. If I were to entertain such thoughts I certainly would seek counseling so I'm not representative of the offenders either. That said, I find the approach of pharmaceutical castration an abhorrent approach - "when your tool is a hammer, all issues look like nails" comes to mind. With the research on psychological issues like PTSD, Smoking, Alcohol, other Addictions responding to psychoactives like LSD, Psilocybin, and Ketamine in conjunction with counseling, why just pursue a therapy that can only be studied (ethically) in a very distant cohort such as those who would seek help prior to offending?
Sarah Nelson
Where to begin?? Sex abuse is only partly sexual in the first place. 1) The motivations and drives of sex abusers are not uniform but different- what about this sample, what is their own abuse background?Similar or different? Sex abuse could be eg. the possessive sense of entitlement to women and girls; male abusers of small boys nearly all abused themselves and acting out obsessionally on others- they need to be reconnected to their own pain; rape in war is a vicious degradation of the enemy; some cultures despise and look down on others ; etc. etc 2) This sample has huge flaws.These are self referred worried men; my research with male survivors suggest many worry that they may be attracted to children when there's no proof they actually are-most abusers are hidden, are deniers and deny as long as possible; 3) absurdly short time for testing results- ten WEEKS? !4) Sadly the truly vast use and sharing of child abuse images online internationally has revealed how very common sexual attraction to children is- how many are they going to castrate? Or instead should we not try to change many men's thinking and behaviour instead? 5) Medicalisation of profound social problems is not the answer but always popular in psychiatric and pharmaceutical circles, where vast numbers of "disorders" are generated., .And this treatment is not ethical whatever we think of abusers. Dr Sarah Nelson Universities of Edinburgh and Dundee
Signguy
This, as with most other "disorders" is a choice of our will, not a disorder.
Neil McKechnie
This sample study is laughably small and difficult to take anything serious from or evaluate what it hopes to achieve, other than to give a false impression to the reader that through research and pills we can eradicate paedophilia. I believe it is dangerous to refer to paedophilia as a disorder, as this classification panders to the idea that we should somehow mitigate against their crimes and treat them as a victim and in doing so forget the often life-long damage caused to children. The reality is that a component of paedophilia is about power and control and less about sexual attraction. We need to remove paedophiles from society and psychologically study them to see what influences them so that we can protect children. Only through studying their thought processes will we ever be able to know if treatment through therapy and behaviour modification is even possible but one tool which could be implemented, for the few who have demonstrated genuine remorse and revulsion for their crimes, is regular polygraph testing by an expert examiner to ensure that they are representing a practically zero risk to children.