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  • BIOETHICS FORUM ESSAY

#MeToo and Health Research Ethics

As a public health researcher interested in brain injuries in sports, I was searching for peer-reviewed literature that examined cultural pressures that cause athletes to minimize symptoms of potentially serious injuries when I came across a 1994 article entitled, “A Little Pain Never Hurt Anybody: A Photo-Essay on the Normalization of Sport Injuries.” The identity of one of the authors cast the study in a suspicious light: Dr. Richard Strauss, the Ohio State University physician who has been accused by more than 100 former students of sexual abuse.

His article was a “visual study” with numerous photos of student wrestlers. It claimed to “convey some of the details and social ambiance of today’s approach to collegiate sports medicine.”  A research method that involves photographing injured students, both at the time of injury and while undergoing medical examinations and surgical procedures, also involves significant intimate contact with a vulnerable population. In such circumstances, patients must be able to fully trust the researcher’s integrity, honesty, and respect for persons.

The irony that a doctor accused of groping his patients’ genitalia also studied the cultural belief that “a little pain never hurt anybody” astonishes me. Furthermore, I am concerned about the implications of accused serial sexual abusers publishing in academic literature: that they can use their position of authority to not only enhance their professional status but also to shape academic knowledge. According to Google Scholar, at least 117 articles have cited Strauss’ photo-essay. One 2005 article described it as an example of how the technique of photo-interviewing provided “a way to get people to talk about more difficult and abstract concepts.”

Researchers citing Strauss’ work at the time, of course, would not have known about the abuse allegations against him. But today it is impossible not to wonder if Strauss appropriately used the technique of photo-interviewing when conducting research on college athletes. The International Visual Sociology Association Code of Research Ethics states, “The professional and public trust rests on the ethical behavior of people doing ethical visual research.” If a physician may have assaulted students in his care, this raises the question of whether he may also have conducted research unethically.

Strauss is not the only prominent doctor accused of sexually abusing patients who has also published frequently-cited academic work based on studying patients. Perhaps most notably, Larry Nassar, the former USA Gymnastics team doctor and convicted serial child molester, published multiple articles and chapters on the epidemiology and treatment of gymnastics injuries.

The similarities between Strauss and Nassar become even more troubling when one considers that both physicians employed pseudoscience and unfounded medical techniques to abuse their victims. As reporter Mark Gillispie pointed out, Nassar used illegitimate scientific explanations regarding bone and muscle to justify his “treatments” of athletes, and Strauss claimed that he needed to examine the lymph nodes as a reason for manipulating wrestlers’ genitals.

Through their peer-reviewed publications these physicians may have violated the trust of fellow researchers who depend on the literature to advance their understanding of athletes’ health. Each citation to a researcher’s work enhances the researcher’s professional profile, visibility, and credibility while shaping the formation of knowledge. Scientific research cannot be separated from the methods its author uses, from their social context, and the most fundamental questions of trust and ethics. How can doctors and researchers rely on studies by authors who have violated their patients? And how does such an abuse of trust reverberate throughout decades of scientific literature?

Given what I know, I will not cite Strauss’ article in my own work. I am unable to trust either his research methods or his conclusions. But my discovery of his authorship occurred by happenstance, and my ability to thoroughly evaluate the research he conducted is limited. I therefore also wonder how journals should approach such studies published in their pages. Should these articles be investigated and possibly retracted, or should a note be appended that indicates the scope of the crimes their authors committed? Should the answer to these questions be different in the case of Nassar, who was convicted of abuse, compared to Strauss, who killed himself in 2005 and whose case remains under investigation?

His peer-reviewed articles, of course, represent just one component of the professional prestige Strauss obtained. He served as a team doctor for a prominent university, was editor-in-chief of The Physician and Sportsmedicine for over a decade, and cofounded the American Medical Society for Sports Medicine. But even if his research articles represent just one subset of the processes that may have facilitated abuse, at a minimum a widespread reliance on academic research conducted by abusers, both convicted and alleged, warrants serious conversation. As the #MeToo movement continues to reveal, the dynamics that enhance an abuser’s authority all too frequently protect abusers at the expense of victims.

Strauss expressed the hope that his photo-essay on the normalization of sport injuries might illustrate the process by which even serious injuries could become defined as “routine and uneventful.” It is my hope that his article can, instead, prompt greater insight into ways that serial abuse might be facilitated and further consideration of how academics can most ethically respond to revelations that a body of literature in their field may have been written by a perpetrator.

Kathleen Bachynski is a postdoctoral fellow at the Division of Medical Humanities at NYU Langone Health, studying public health and sports safety. Twitter: @bachyns

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Published on: March 8, 2019
Published in: Conflicts of Interest in Research, Hastings Bioethics Forum, Professional Ethics

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