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Esther Choo MD MPH @choo_ek
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When we talk about improving the response to sexual harassment, a common response is concern for an increase in false positives. (And I do not mean to pick on @clayton_kazan here; he just asked it on a recent thread - thanks CK.)
First understand that we are enormously, egregiously, embarrassingly erring in the opposite direction. The burden of proof is so huge, the paths to reporting so fraught with its own punishment, the consequences minor even for established harassers...
We are absolutely sucking it with our response to *definitive* cases of abuse and harassment. The idea that we are *also* at the precipice of overshooting and making heads roll left and right over alleged sexual harassment that might be undersupported - seems highly unlikely.
Nevertheless, should we also be concerned about the rare false accusation? Of course.
Here’s the problem (and once again it helps to use our approach to chronic disease): the current system has high specificity and almost NO sensitivity. The specificity is guaranteed by a number of things, many of which I do not think are at risk of changing soon.
They include:
- a strong disinclination for finding powerful (mostly) men at fault
- a requirement for investigation, typically by internal body loyal to the interests of the institution
- due process in every investigation
- usually, steep power differential favoring the abuser
When we talk about improving the response to harassment, we are talking about increasing the *sensitivity* of our evaluation for harassment.
CAN A TEST HAVE BOTH HIGH SENSITIVITY AND HIGH SPECIFICITY?
A. No; they are like a seesaw. When one goes up, the other goes down.
B. Yes; these are not mutually exclusive.
C. Yes; and also you can also combine tests with these characteristics to achieve your goal.
(Sorry - need an intermission ... got to go set up an Xmas tree so the littles aren’t disappointed. Back later to continue this. And don’t worry - will get to PPV!)
Okay, back with mission accomplished! So... back to improving the sensitivity of our detection of sexual harassment (I speak mostly about healthcare here, this being my milieu, but I don't think it's much different in other major industries).
There are many excellent suggestions in the recent National Academies of Sciences, Engineering, and Medicine report on sexual harassment in academia: nap.edu/catalog/24994/…. I can't do it justice here, but I'll outline some of the high points.
Briefly:
1. Measure occurrence of sexual harassment using validated measures
2. Implement best-practice, standardized policies to identify and respond to harassment charges
3. Make policies visible, accessible to employees
4. Have procedures that ensure follow through of such policies
5. Diversify the workforce and leadership
6. Create a workplace culture that is inclusive, equitable, and respectful
7. Avoid the steep hierarchies that make abuse by a senior perpetually tolerated
8. Engage the "gatekeepers" so receipt of coins of the realm (e.g., grant funding) are affected by confirmed harassment
There are others, but those are the ones floating to the top of my brain right now.
To me, these as a whole should increase primary and secondary prevention of harassment and reduce barriers for reporting. Yet I don't see that any support false reporting - actually, some, like having a more inclusive and respectful environment would likely do the opposite.
And they do not negate the things I mentioned above that provide specificity - clearly, the investigation phase - the "colonoscopy," as @RogerJLewis are discussing behind the scenes now - needs innovation, too, to add sensitivity rather than pure specificity.
For anyone with the patience to follow this far, to be continued... sleep beckons.
So why do people so fear the false sexual harassment accusation? I think there are several reasons.
1. As humans, we don’t fear in proportion to likelihood. We fear worst case scenario. I think discussion of this topic triggers “what if,” even if data supports a false positive is far, far less likely than a false negative, even with the kind of upgrades I mentioned.
2. What happens when we have a HIGHLY specific, non-sensitive system of identifying sexual harassment? I alluded to it above: lots of false negatives. What is the public’s perception of false negatives? **That they were TRUE negatives, falsely accused**, right?
So in a way, the ineffectiveness of our current system *creates* a specter of false positives that fuels resistance to improving the system.
3. Consider another consequence of a system that tends to capture and penalize only the most definitive, egregious cases of harassment. The appropriate response to those cases is severe, right?
(I’m not talking about those cases hushed up, pawned off on other institutions, etc. I mean the unusual case where punishment is open and visible.)
This introduces an availability bias - the cases we see receive harsh, definitive punishment. So it gives people the impression that there is a complaint (true or not, many seem to be not true, ey?) then boom, you're out of a job and permanently shamed.
In a low sensitivity system, there’s no room for gradations or variability in severity of harassment. There’s little chance to learn, either. Imagine if we only got to discuss medical error when they resulted in death. Or if every M&M resulted in the physician getting fired....
We’d worry about false attribution THEN, wouldn’t we?!
This feeds into the next point, 4. We fear what we don’t understand. On this very thread we have ppl expressing uncertainty about what constitutes harassment. The shame, secrecy, avoidance that characterizes our response to harassment just fuels this free-floating anxiety.
Hope not too annoying to self-quote, but from our @NEJM essay, “By making discussions of gender-based harassment routine and system-focused — taking a preventive approach that seeks a broad range of solutions well before the point at which sexual-harassment charges are made...”
...and legal actions taken — we gain the opportunity to examine harassment openly and frankly.” nejm.org/doi/full/10.10…
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