I am a bioethics researcher who studies physician misconduct. I am also a former gymnast.

I haven’t really kept up with gymnastics since I quit when I was 17. With the exception of the most recent Olympic Games, I avoid watching it on TV. The taciturn criticism from the commentators is too much for me to bear. I think, of course, she didn’t stick the landing. She just flew through the air at top speed doing something no human has ever done before! Then I throw the remote. Twenty-five years later, I’m obviously still a bit raw. So I have tried to ignore the Nassar story. But given that I am a bioethics researcher who studies physician misconduct and a former gymnast, people keep asking me to weigh in.

I recently collaborated with Jim DuBois and his team at Washington University to examine 101 cases of sexual abuse of patients by physicians that occurred between 2008 and 2015 (publication forthcoming in Sexual Abuse: A Journal of Research and Treatment). Physician sexual misconduct happens more often than any of us would like to think, and when it does happen, institutional cover-ups are common. But the real problem is silence, more so than smokescreens. So am I surprised that physician sexual abuse occurred in the realm of gymnastics? Not at all. Having been a gymnast for almost 15 years, I’m familiar with silence.

All patients are vulnerable, their lives literally in their doctor’s control. Children are told to trust adults, especially doctors. Therefore, children make especially vulnerable patients. And I would argue that many gymnasts are more vulnerable than the average child, because gymnasts are children with adult-sized concerns. They are 14 year olds with careers at stake. Any gymnast worth her salt feels a take-a-bullet-sized responsibility to her teammates and to her coaches. They are her whole life. She is grateful — and may often feel guilty — for all the sacrifices her family has made for her career. To lose, to quit, to complain, to cause trouble, to make noise, is to let everyone down. To put it in perspective: at age 14, Nadia Comaneci scored the first perfect 10 in Olympic competition — and she tried to kill herself by drinking bleach. What hope is there for the rest of us mere mortals? (This suicide attempt was featured in the 1984 television biopic, Nadia. After years of denial, Nadia confirmed the incident in a 1990 Life interview.)

I wish I was able to offer a more sophisticated analysis of the problem than a cynical resignation to the fact that adults in power hurt kids. When I sat down to write this, I wanted to be scholarly. Logical. Unemotional.  But I can’t. Stop. Thinking. About all the times I was silent.

I think about the chiropractor who came weekly to treat our injuries. We complained about Scary Larry’s bad breath. We wondered why we had to take our shorts off if he was there to look at our knees and ankles.  We whispered to each other — but certainly not to any parents or coaches.

I think about a younger teammate, a girl I loved like a sister and with whom I spent more time than my own sisters. After multiple consecutive ankle surgeries and months on crutches, she developed carpel tunnel in her wrist, which required yet another surgery. She kept on in gymnastics for years after that, never one to complain.

I think about the lonely, sad-eyed girl from Indiana who we always saw at competitions.  She was the sole member of her team, and we immaturely joked that she and her male coach — in too-tight pants and silly permed hair (it was the 80s) — were “boyfriend and girlfriend.” We didn’t dare go talk to her.

I think of the time I broke my elbow at practice but was cut out of the cast a few days later so that I could go to a competition.  It was Nationals, so of course, I didn’t argue.

I think of when my own lower back problems first started. I struggled to articulate where exactly the pain was. It turned out to be sciatica — which I described as somewhere “between my groin and my butt.” (I was fourteen.) This prompted one of my coaches to think it might be a “woman problem.” But another doctor’s visit would mean missing practice. So the father of another gymnast who was a gynecologist examined me during practice — in the bathroom. I was too mortified to ever talk about that — but for the wrong reasons.

These things happened to me and my friends before we were old enough to drive. If you’re wondering why I didn’t say anything (if I’m being honest, I truly didn’t realize that any of this was not normal until I was in my mid-30s — and in possession of a PhD in bioethics), I really can’t put it any better than former gymnast Jennifer Sey, writing in her recent New York Times op-ed:

In such an environment, you learn to focus only on achievement and to disregard your own sense of right and wrong, along with your own well-being. Because of this, I can understand how young gymnasts might be confused about whether and how to speak up for themselves when they’ve been mistreated.

Reading this, it occurred to me that training in gymnastics is similar to training in medicine. Just replace “gymnasts” with “medical students” — they too learn to focus on their achievement, often sacrificing personal well-being. We educate physicians on what counts as abuse, harassment, and unprofessional behavior. But the “hidden curriculum” teaches that if you report someone for “bad behavior,” it reflects poorly on you, not necessarily on them. The stakes are even higher for other health care providers like nurses who are almost always subordinate to physicians.

On April 6, it was reported that Nassar’s medical license has been suspended for three years, and he will have to pay $100,000 if he wants to apply get it back. If found guilty, he may likely (but not automatically) lose his license permanently. I urge members of the medical community support the young women who have so bravely come forward to speak out against Nassar. The culture of silence must end: in gymnastics, and in medicine.

Emily E. Anderson is assistant professor, Neiswanger Institute for Bioethics, Loyola University Chicago, Stritch School of Medicine, Chicago, IL.

Image credit: Shutterstock.com