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Osteopathic field soul-searching amid Nassar fallout

Kim Kozlowski
The Detroit News

Nearly 20 years into his career, Dr. Saroj Misra recently faced patients wanting to know more about osteopathic medicine — and a notorious doctor whose sexual misconduct put it in the spotlight.

The Nassar scandal has osteopaths reviewing what they do, and how they do it, said Dr. Saroj Misra, left, with medial student Kenchiro Kue and resident Samih Ajami at his Warren office.

What was Larry Nassar doing? Are you doing similar things? Should I be worried?

Only a few patients asked about the techniques used by Nassar, the former Michigan State University and USA Gymnastics osteopathic physician who sexually assaulted more than 250 young women over two decades.

But spoken and unspoken questions have swirled in Nassar’s wake, prompting conversations about his impact on physicians’ practice and medical schools’ curriculum — and how doctors can reassure patients and continue caring for them.

The conversations are happening on every level across the nation, from medical schools to residency training programs to professional organizations, because this is one of the first times an osteopathic physician has gained prominence for shaking the foundation of trust between doctor and patient.

“There is a lot of soul-searching, a lot of reviewing and reaffirming, not only why we do what we do but how we do what we do,” said Misra, program director of family medicine residency at St. John Macomb Oakland Hospital in Warren.

“While osteopathic manipulation is not the key aspect of being an osteopath, it is a critical component of osteopathic medicine,” added Misra, who also holds a faculty appointment with the MSU College of Osteopathic Medicine in family and community medicine.

“Because it is in the spotlight, many of us feel the need to examine what we do, how we do it and ensure that we’re continuing to care for the patient in a safe and appropriate way when we use it.”

Osteopathic doctors are one of two groups of fully licensed physicians in the United States, making up 10 percent of the nation’s doctors alongside allopathic — better known as medical doctors.

Osteopathic doctors are educated and care for patients in similar ways as MDs do but have a different philosophy. They partner with patients to promote wellness and regard the body as innately able to heal itself. Their care sometimes includes hands-on, manipulative treatment to diminish pain, restore motion and help the body function efficiently.

Students enter and leave East Fee Hall, home of the MSU College of Osteopathic Medicine in East Lansing on Friday, Feb 23, 2018.

Ripple effect at MSU

It was manipulative treatments near the pelvic floor and other areas that Nassar told scores of young women he was using to heal their injuries. But under the guise of treatment, he sexually assaulted his patients, many of whom were gymnasts, including some Olympic champions.

Nassar may be behind bars for the rest of his life but the breadth and depth of his crimes has created a ripple effect among health care professionals, especially in osteopathic medicine.

From East Lansing to San Diego to Kirkville, Missouri, osteopathic doctors and medical students are taking steps to heighten the awareness of ethics and patient relationships through task forces, discussions and special seminars at annual conferences.

But the epicenter of the crisis is at Michigan State, where Nassar trained, practiced and sexually abused patients in the College of Osteopathic Medicine.

“It was devastating to everyone,” said Jake Sims, a third-year student in the osteopathic medical school. “I have had many conversations with people about how it could have happened for so long ... The biggest part is this one man does not embody who we are as osteopathic physicians. It’s unfortunate to get lumped into the same category as someone who did something so terrible.”

Michigan has seven medical colleges but MSU is the only one with two medical schools, where a future doctor can train in allopathic or osteopathic medicine.

The MSU College of Human Medicine has 813 students enrolled while the MSU College of Osteopathic Medicine has 1,237 students.

So far, the Nassar scandal has not affected applications to MSU’s osteopathic medical school: 5,783 students applied to be part of the class that will enter in June 2018, spokeswoman Laura Probyn said.

“As of Feb. 22, 300 admitted applicants have accepted an admissions offer,” she said. “That is a full class.”

In the wake of the Nassar scandal, there was a leadership shakeup at all levels of the university. Former President Lou Anna Simon stepped down in January, the same day Nassar was sentenced to 40 to 175 years in prison for first-degree criminal sexual conduct.

William Strampel — the former dean of the osteopathic medical school and Nassar’s boss — took a leave of absence for medical reasons in December.

MSU interim President John Engler, who replaced Simon last month, has moved to fire Strampel from the faculty and suspended Suresh Mukherji, chairman of the Department of Radiology and chief medical officer of the MSU HealthTeam.

Dr. Andrea Amalfitano stepped in as the interim dean of the university’s College of Osteopathic Medicine. Days after his appointment, he moved to address the fallout from the scandal.

Amalfitano, a professor of pediatrics, microbiology and molecular genetics, canceled an annual fundraiser for the college out of respect for Nassar’s victims, held town hall meetings with osteopathic medical students and set up a task force to address concerns.

The task force, which includes faculty and students, has identified priorities that include examining MSU’s osteopathic curriculum to make sure it is appropriate for contemporary medical practice.

The task force also will examine student concerns about the need for transparency and their feelings about what Nassar did as a member of their future profession.

“Their concern is that no one understands how bad they feel for the Nassar survivors,” Amalfitano said. “There is a deep, deep emotion that even though they recognize the sadness they feel is nowhere near what the Nassar survivors have gone through or felt, they also feel bad that this person who claimed to be a physician committed these heinous acts portraying to be a physician. That hurts to the core.”

Addressing the concerns is the only way to heal from the situation, Amalfitano said. That’s why he is trying to recognize the issues, deal with them and move on.

“We don’t want to minimize or ignore or in any way not accept what happened,” said Amalfitano.

‘We have to face the problem’

Meanwhile, Stephen Shannon, president and CEO of the American Association of Colleges of Osteopathic Medicine, announced the formation of a Task Force on Ethics and Professionalism in January.

He appointed as chair Margaret Wilson, an osteopathic doctor who is dean and professor of the Department of Family Medicine, Preventive Medicine and Community Health at the A.T. Still University of Health Sciences, home of the nation’s first osteopathic medical school in Kirksville, Missouri.

“We want to send a clear message that we want to examine any issue that might be of concern relative to ethics, curriculum governance and, ultimately, professionalism,” Shannon said.

Two upcoming conferences for osteopathic physicians will include presentations on doctor/patient/athlete relationships and sexual assault issues.

Rebeccah Rodriguez Regner, board secretary/treasurer of the American Osteopathic Academy of Sports Medicine, said the organization will feature sessions on those topics at the American Osteopathic Association’s annual conference in October in San Diego.

Meanwhile, Steven Karageanes, a Livonia sports-medicine doctor and former national president of the American Osteopathic Academy of Sports Medicine, said he will be part of a session at the organization’s conference in Columbus in May.

He wrote in a commentary for the American Osteopathic Association that Nassar’s harm comes into focus “when you consider the vast network of physicians, therapists, trainers, and coaches who sent athletes to him for over 25 years.”

Karageanes, who knew Nassar for 26 years and referred patients to him, wonders if he missed something along the way. But he insists the profession will overcome the fallout from Nassar’s crimes.

“The fact that one guy was assaulting women and pretending to do manipulations will not impact our profession,” Karageanes said. “There are way too many people in our field that will never allow this to stop our mission. But we can’t put our head in the sand and make it go away. We have to face the problem.”