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Michigan State University Pays out $500 million in Settlements to Larry Nassar Victims. A Precedent

I am certain that all victims of health care injuries, especially when it seems to be systemic in nature, have paid attention to this head-line. Perhaps the tide of endemic cover-up is changing. There are a couple of crucial aspects to the entire MSU case that have escaped attention but are of fundamental importance in the ethical evolution of health care. The first point is that no physician, especially no male physician should be handling the genitalia of children (especially girls) to the age of 18, except under very special circumstances. This point was emphasized to me when in discussion of the Nassar case, a female physician friend of mine described that as a girl she was always terrified when her mother took her to the general pediatrician because the older white male would aggressively examine her genitalia. She described that after one of these annual check-ups, at about the age of 6, she asked her mom to stop the car so she could throw up. Yet, as children do, she never told her mom, not as a child and not even now. So she was terrorized as a child and traumatized now.

So between the Larry Nassar case and the account of my physician colleague, a few things became very clear to me. Children, especially girls, know very well, innately, when something being done (especially when it comes to intimate regions of their body) to them is wrong and psychologically damaging. I do not have the time for this right now to contact Pediatric societies, but maybe someone of influence will read this post. As a physician of 28 years academic experience, it is fair to say that there is almost never a reason for a general pediatrician to examine the genitalia of girls (possibly also boys) unless the mother has drawn attention to it, and maybe even then the parent should be directed to take the child to a pediatric specialist in urology (if urinary tract issues are a problem, or male testicular descent) or gynecology (ambiguous genitalia, primary amenorrhea). There is never an indication for a general pediatric physician (some may not like the fact that I mention 'male') to examine the genitalia of children, especially young girls. Larry Nassar was a sports physician, so it is even more definitive for them: never an indication to examine, touch, manipulate the genitalia of children. All pediatric societies, all sports medicine societies must take this up as a central issue in reform of practice. My instinct tells me that there are likely hundreds of older white male physicians who have abused young girls over the years in this fashion. MRI without contrast (thankfully without contrast) is likely the best way to examine ambiguous genitalia for gender assignment and primary amenorrhea- but this must be done by a radiologist with expertise in this area. I am also reminded that having done many research protocols for MR contrast in the past, one of the physical exam questions asked is genitalia. This should also be stopped. Essentially no looking at genitalia unless specifically requested, and on most occasions this must be deferred to specialists. Certainly not for screening physical exams. The second major lesson overlooked is: the Dean of the Osteopathic School, that Nassar was a member of, was arrested for having pornographic images, apparently of osteopathic students on his computer, and sordid emails with them. This ofcourse proves the wisdom of the ancient Greek saying, the fish rots from the head, when senior administration is corrupt the lower level administrators take their code of conduct from the top. What is striking is that there has been no public complaint of any of these women about this abuse. Probably atleast 20 women abused, molested by this individual. The second point: sexual abuse, sexual harassment, sexual assault is likely as serious a problem in health care, as in any of the fields (entertainment, politics, military), which have been reported in the news to date. Maybe worse than many. Yet no women, especially no female physicians, have come forward to complain. Why is that? Strange also that I as a male physician am drawing attention to this, but my mother was a radiologist (passed away 2 months ago) and my partner is a female radiologist, so this is a subject I have familiarity with. Stay tuned for an upcoming blog.

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