1. Priests and sex abuse

2. Treating pedophiles

3. Does it work?

4. Is he safe?

The hormone-producing testes are removed in physical castration. But testosterone pills can allow the patient to resume sexual activity. Federal Consumer Information Center.

The question may be simple, but the answer is elusive. Given the illegal, not to mention shameful, nature of sex offenses, you can't just ask offenders. "There are special problems with sex offender research," says Grossman. " How do you know if they recidivate unless there's an arrest or conviction record? But approximately 97 percent of sex offenses don't come to the attention of police, and fewer are convicted."

And that's just for starters. Other issues make it difficult to trust studies, or compare and compile them:

Who was treated? Those most likely to reoffend? Least likely? Those most likely to benefit? First offenders? Hard-core offenders?

What was the treatment, exactly?

Was treatment done in or out of prison?

Was castration used?

Was the measure of success not committing another sex crime? Any crime?

Was the comparison group randomly chosen from similar offenders? Men who refused treatment? Men who left treatment?

How long was the followup?

Studying the studies
To understand the difficulties with both treatment and its assessment, look at a brand-spanking new study of treatment of sex offenders (including pedophiles). The researchers examined 43 previous studies that compared 5,078 treated sex offenders to 4,376 untreated ones. The average followup after treatment with cognitive-behavioral therapy was 46 months (see "Effectiveness of Treatment..." in the bibliography).

The overall rate of sexual recidivism among treated men was 12.3 percent, compared to 16.8 percent for untreated men. The difference – which the study authors called a "small advantage" – was statistically significant, meaning it probably didn't happen by chance.

The study reported its findings in terms of "odds ratios." (Odds ratio is a statistical term that means roughly this: If the OR is 0.70, for every 100 untreated offenders who reoffend, 70 treated ones will commit another sex crime.)

Three studies used the most reliable technique: randomly assigning offenders to treatment or a comparison group. One produced a highly effective OR of 0.22. Treated men in the second were more likely to reoffend, although the conclusion was not statistically reliable. The third found no difference from treatment!

In 17 studies with non-random comparison groups, treatment was effective, but hardly perfect (OR = 0.62).

Offenders who refused treatment were no more likely than treated offenders to commit further sex crimes.

Offenders who left treatment had "consistently higher recidivism rates" than those who completed treatment (OR = 0.47).

What we've described is called a meta-analysis – a way to use existing data to derive the kind of firm conclusion that can only come from a huge study. You don't need a Ph.D. in sociology to recognize confusing results. Here's what Lucy Berliner of the Harbor View Center for Sexual Assault & Traumatic Stress in Seattle, wrote in a commentary: "... Cautious optimism is warranted for modern approaches to sex offender treatment. ... Sex offender treatment specialists can take heart that there is scientific support for their efforts as long as the therapies they deliver are consistent with the approaches used in the studies that show promise for reducing recidivism."

However, she added that "the effect sizes for recidivism reduction are not large, thus there will still be failures, the cost of which will be borne by victims....The bottom line? Optimism, yes. But with caution."

In a 1991 study, only 7.4 percent of 406 pedophiles committed further sexual crimes over a five-year followup period. "We missed some [repeat offenders], but it's a far cry from the common misconception that they would quickly be back in trouble," says lead author Fred Berlin (see "A Five-Year..." in the bibliography).

FBI most wanted fugitive: Between 1985 and 1997, Frederick Stiles Wanamaker allegedly molested five minor boys in Virginia. FBI.

Against this confusing backdrop, many in the field say treatment must be tried anyway. In ballpark numbers, large studies find that the recidivism rate drops by roughly 30 percent, says Grossman. Higher rates would be better, she says, "But we treat diseases with higher relapse rates than that. A recent study on manic depression found a 38 percent relapse reduction with lithium. But any psychiatrist in the world will treat bipolar disorder with lithium."

Despite the public despair over treatment, as reflected in laws that allow long-term civil commitment, Plaud says they "are not admissions that treatment doesn't work, but admissions that they are not handling it appropriately. The type of treatment required is usually not available, or ... is inconsistent in type, intensity ... and follow-through to probation and parole."

It's my child at risk... Is this man safe?

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