It wasn’t until Terrie Light had children of her own that she revealed her darkest secret: She had been raped, at the age of 8, by a priest in the rectory of a church in the Oakland Diocese.
“It was a violent, sadistic attack. I kept it inside of me for years,” says the 51-year-old mother of six. “When my oldest son turned 7, I couldn’t ignore it any longer. I was a good Catholic girl — obedient, respectful. I always felt guilty because I was pretty. I tried not to be attractive because I thought that being attractive was somehow sinful. I think a lot of sex abuse victims were good Catholic girls.”
Light, the Northern California representative of the Survivors Network of those Abused by Priests (SNAP), who eventually reached an out-of-court settlement with the church, hopes a new California law suspending the statute of limitations on sex abuse will give others like her the courage to finally come forward and begin to shift national attention in the burgeoning clerical abuse scandal to include a hidden but major population of victims — women.
Abuse survivors, along with their attorneys and psychologists, say that sexism and social conditioning, magnified many times over within the Catholic Church, have led to the trivialization of harm suffered by women who have come forward to finally report abuse by priests. At the same time, these same factors have caused women to be ashamed — and keep silent — about their experiences.
“There’s no question that abuse of women [by priests] has been vastly underreported,” says A.W. Richard Sipe, a former priest and psychotherapist who has studied priests’ sex lives for more than 30 years. “There’s a tremendous bias against women in the U.S. — and the world — and a tremendous callousness about sexual abuse against women.”
No secular organization has statistics on the total number of people abused by priests; the most complete numbers are held by church officials, who aren’t sharing. But attorneys and survivor networks estimate that from one-third to over a half of all victims of sexually abusive priests are women. And criminal cases filed in the last year in Los Angeles County involve approximately the same number of male and female victims.
Gary Schoener, a Minneapolis psychologist whose Minneapolis Walk-in Counseling Center has worked on more than 2,000 cases of clerical sex abuse, says the majority of clerical abusers that he and his staff deal with (from several denominations) victimize girls and women. Yet, he says, public perception is that far more males are abused, and that the harm they suffer is more serious than what females experience.
“Women and girls are every bit as much at risk as boys and men,” says Schoener. “But the sexual abuse of a boy is treated far more seriously, and is considered a far worse offense. Men are regarded as too strong to be victims; their victimization is somehow more shocking to the public. Women are expected to put up with more.
“The press also tends to cover — and the big damage awards go to — the boy cases,” he adds. “The altar boy cases tend to make better copy — they’re more salacious.”
Schoener says notorious, headline-grabbing cases of “gross mismanagement” in places like Boston, where predatory priests were moved from one parish to another and given easy access to large numbers of altar boys, tend to distort the real picture of sex abuse in the church.
To begin with, women appear less likely to report abuse, says Schoener. The shame of sexual abuse is similar for both genders, but women tend to be “trashed” by church officials and supporters as being seductresses, he says. “We have seen girls as young as 10 portrayed as sirens.” Reporting sex abuse also tends to have more serious ramifications for a woman’s marriage.
“A lot of men blame their wives for abuse and are shocked by the sexual history,” says Schoener. “Societal preoccupation with virginity at the time of marriage cuts across many cultures. It’s mind-bending.”
An important factor in the underreporting by women, and their greater emphasis on shame, says Schoener and others, comes from the idea that women in the Catholic Church toil in the shadow of Eve. Just as Eve is portrayed by the church as being responsible for original sin and leading Adam astray, so too are tantalizing teenage girls characterized as responsible for some priests’ downfall.
“The church is so dominated by men that there’s a tendency to portray girls as provoking the crimes against themselves. The depositions read like rape cases used to: Did you enjoy it? What were you wearing?” reports Susan Gallagher, a political science professor at the University of Massachusetts at Lowell. Gallagher won a $250,000 settlement after being sexually abused at the age of 14 by the Rev. Frank Nugent, a priest who ran a youth camp in Ellenville, N.Y., for the Salesian Catholic order. Nugent also worked at the Don Bosco Preparatory High School in Ramsey, N.J. He was later transferred to Massachusetts. “There’s also a homophobic view that sex with girls is somehow more natural, that some of these priests were just being red-blooded American men.”
This attitude was epitomized by Cardinal Francis George of Chicago when he spoke out last spring against a zero-tolerance policy for sexually abusive priests. Indicating that sex between priests and teenage girls is somehow more forgivable, he said: “There is a difference between a moral monster like [Boston priest] John Geoghan and a priest who, perhaps under the influence of alcohol, is involved with a 17-year-old girl who returns his affections. Both are crimes, but in terms of the possibility of reform, they are very different sets of circumstances.”
Adult women who have been abused face the toughest fight of any, Schoener believes. Their abuse by priests — often during spiritual or marital counseling sessions — wins little public attention compared to abuse of children. In addition, they are often held responsible for the relationship.
The pattern of lawsuit filings also shows that suits tend to be filed primarily on behalf of men, according to several attorneys. Jeffrey Anderson, a St. Paul, Minn., lawyer who is considered the nation’s predominant litigator in Catholic clergy sex-abuse cases, says that of the 700 cases he has filed, about two-thirds of the victims are male and one-third are female. That’s the opposite ratio of sex-abuse cases in the general population, where two-thirds of the victims are female and one-third male.
“Women have been discouraged culturally, and especially by the Catholic Church, from reporting abuse,” says Anderson. “Often, when they go to a church leader to talk about an assault, they are rebuked rather than helped.” Anderson’s own daughter was assaulted at age 8 by a former priest — during therapy. “I had no idea until I had been doing this work for 10 years,” he said. “She suffered for years in silence and shame.” His daughter’s perpetrator was successfully prosecuted, he said, but “she still wears the scars very painfully.”
Many of those who are convinced that abuse of women by priests is vastly underreported still suspect that, overall, more males than females have been abused by priests, primarily because priests have more access to boys after Mass and in sports programs. “It’s easier for priests to spend time — and time alone — with boys,” says Gallagher.
In fact, many abusive priests are alleged to have attacked children of both sexes, which is evidence that opportunity is a key factor when it comes to which children are victimized. “Of thousands of cases across the country that I’m familiar with, a significant number of priests abuse both boys and girls,” says Sipe. “It’s a question of who they can get their hands on.”
Gallagher said her older brother, Patrick, was repeatedly abused by her abuser. Patrick, who Susan said had become suicidal because of the abuse, died at 25 in an accident driving a car owned by Nugent’s order, the Salesians.
The public impression that abusive priests preyed only on boys hasn’t just caused abused women to feel pushed aside. It has provided fuel for a drive on the part of conservative Catholics to rid the priesthood of gay men, who, Sipe estimates, make up about a third of the priesthood. The focus on boys is encouraged by the Vatican, says Sipe, and is seen to provide convenient scapegoats — gay priests — for a problem that has nothing to do with the issue.
In the Vatican’s first comments about the developing American scandal last spring, Joaquin Navarro-Valls, chief spokesman for Pope John Paul II, said gay men should be barred from the priesthood. “People with these inclinations just cannot be ordained,” he said.
The public perception that sex-abuse victims in the church are almost exclusively men is so distorted, says Gallagher, that men who attend SNAP meetings are surprised to find women there — and women are astonished that they are not alone in a sea of men. This sense of isolation only serves to keep women silent about their abuse, says Gallagher.
Gallagher says that even when women have the courage to come forward and publicize their abuse, they are often shunned. She says she has protested repeatedly about the lack of coverage of female victims of priest sex abuse. She took her complaints to the Boston Globe, which spearheaded coverage of the Boston priest abuse scandals, but the paper, she said, failed to cover her story despite several interviews. Gallagher then turned to the New York Times, which did run a story about her abuse.
Meanwhile, a Globe ombudsman responded to Gallagher’s complaints, saying that a story about female victims of priest sex abuse was on its “to-do list” and that “a four-person reporting team can only do so much.” The Globe finally did a story on Dec. 27 about female victims in the Boston Archdiocese — almost nine months after the Times.
“If by [the Globe's] own admission as many as a third of the victims are female, I don’t think a single story does it,” says Gallagher. “The press has to keep up coverage of female victims so that more people come forward. I told my story because I thought it would do some good — that others would see Father Nugent’s name and come forward. He was working for years with children.”
Gallagher says she knows victims so mortified by their experiences that they’re “waiting for their parents to die” before they’ll come forward. Light says she was relieved when her attacker died. She remained frightened of him even into adulthood. “These priests seemed almost supernatural to us when we were children,” she said.
The amount of fear, shame and self-loathing experienced by victims of abusive priests has tended to be the same regardless of the victims’ genders, says Schoener. And the patterns of abuse also are similar. Attorney Michael Meadows of Walnut Creek, Calif., says he consistently finds eerie parallels in the cases of male and female clients.
“It’s uncanny how similar these cases are,” he says. “These kids were abused at 12 or 13. They’re singled out by priests as being from broken or troubled homes. They’re least likely to have someone to turn to. Then it gets buried for years and years. Their lives deteriorate. At some point in their late 20s or mid- to late 30s they hit rock bottom. That’s when they confront what happened to them, but under the statute of limitations it’s usually too late.”
The statute of limitations often means that cases are lost before they’re even filed because of a “technicality,” says Meadows. “These people have lives with a deep, dark secret for years. It doesn’t mean these people suffered any less because time has passed. These are some of the most psychologically damaged people you can imagine.”
But the new California law, the first of its kind in the nation, has suspended the statute of limitations on all sex-abuse cases in the state for one year as of Jan. 1, 2003. The law came before the California Legislature last summer at the height of the Boston scandal and passed without opposition. Last month, church officials in California issued a letter to priests and parishioners warning them of an expected flood of lawsuits.
“Some of these lawsuits may involve the revival of already settled cases and some may involve alleged perpetrators and witnesses long since dead,” said the letter. “Under those circumstances, it will be difficult, if not impossible to ascertain the truth.” Church officials have indicated they’re willing to settle many cases without a court fight.
Jeffrey Anderson is joining with attorneys Dave and Larry Divron in Stockton, Joe George in Sacramento, and Ray Boucher in Southern California, to file some 250 suits in California during the coming year. “We expect more as victims see their abusers’ names in the press and continue to come forward,” says Divron. The chances are good that many women will be among the plaintiffs.
Meadows, who plans to file seven cases representing clients ranging in age from 30 to 52, welcomes the California law and says financial compensation does help, but doesn’t go far enough. “It’s one small step on the road to recovery,” he says. “But there’d be nothing better than to see some of these guys behind bars.
“You read the documents and it’s the same over and over,” he says. “Abusive priests were moved from one church to another with no word of warning to anyone. You wonder, where was the one man of conscience looking out for the kids?”
Five years ago, terminal cancer patients were given hope that a longer life — possibly even a cure for the disease — could be within reach. Researchers at several hospitals, including the M.D. Anderson Cancer Center at the University of Texas in Houston, were conducting trials on what was being regarded as something of a cancer wonder drug — an agent that appeared to successfully block a growth factor that turns cells malignant. Abdominal tumors nearly disappeared in a 28-year-old Miami woman taking the drug.
But this year the Miami woman died, months after the federal Food and Drug Administration rejected the application for the drug’s approval, saying some clinical tests designed by the manufacturer had flaws that failed to prove the drug’s effectiveness.
The drug was Erbitux, the company ImClone Systems. The FDA’s rejection sent ImClone’s stocks into a nosedive, and an insider-trading scandal erupted. Only then did the 195 patients who participated in clinical trials at M.D. Anderson learn that its president, John Mendelsohn, held a major stake in ImClone and sat on its board of directors at the same time his researchers were testing the company’s drug.
Patients affected by the ImClone scandal have been lost in the media’s rush to cover the tale of Martha Stewart and other key investors who pulled their money out of ImClone stock just before the FDA decision. Some ImClone company officials and the investors, including Stewart, they may have tipped off are facing investigation. But Mendelsohn’s financial interest in Erbitux and his failure to reveal that interest to patients enrolled in clinical trials of the drug broke no federal law or regulation. In fact, Mendelsohn’s stake in a drug his institution was testing is hardly uncommon in the medical community.
And that’s exactly what upsets a growing cadre of healthcare advocates, lawyers and doctors, who believe the bonds between research hospitals and corporations have grown too strong — and too acceptable. “It’s as if financial conflicts of interest were a given of nature or a constitutional right — which they’re not,” said Harvard professor Dr. Marcia Angell, a former editor of the New England Journal of Medicine.
The integrity of clinical trials has come under increasing scrutiny since a series of safety measure meltdowns and deaths during research trials at some of the top medical institutions in the country. Among the factors in at least some of those tragedies is the link between research and corporate funding. Though there’s no indication that participants in the ImClone trials were harmed, healthcare advocates believe that corporate pressures — and incentives — to rush products to market that could have adversely affected Erbitux research have in other cases been responsible for cut corners and patients not being fully informed of dangers in the trials.
“Human nature is human nature, whether you have an M.D. attached to your name or not,” says Vera Hassner Sharav, head of the Alliance for Human Research Protection in New York City. Financial conflicts “permeate clinical trials — from design to selection of subjects to control of data to what’s reported in medical journals.”
“The cat’s out of the bag,” she adds. “It’s not just a problem with five doctors or 25, or a single institution; it’s the system. Yet patients have no way of knowing if their doctor has a vested interest in a study and if that interest may be superseding a concern about a patient’s welfare.”
Mendelsohn, who developed the drug that was to become Erbitux, has said he did not participate in or influence trials at M.D. Anderson. He told a congressional subcommittee recently that he’s convinced Erbitux “shows great promise” for treating end-stage colorectal cancer. Mendelsohn still holds stock in ImClone, but reportedly earned $6.3 million when he sold a portion of his holdings last year to Bristol-Myers Squibb.
Since the Erbitux trials, M.D. Anderson has changed its policies regarding conflicts of interest. Primary-care physicians and principal investigators are prohibited from financial conflicts of interest. Financial conflicts of co-investigators and the cancer center’s president must now be disclosed in the informed-consent document presented to each participant in a clinical trial. “We’re learning,” said Dr. Leonard Zwelling, vice president for research administration at M.D. Anderson. The corporate-research scene is “evolving incredibly rapidly and it’s not federally regulated. What’s right seems to be a moving target.”
“The question is one of perception. No one has questioned people’s motives, but it looks bad. We’re cognizant of that and addressing it. But these issues are relatively new for us in academics.”
The Institute of Medicine (IOM) of the National Academies warned in a report issued in October that fundamental change in clinical trial research — including the management of conflicts of interest — is critical to keep the system from imploding. “Broader federal oversight is needed to ensure that the health and well-being of people enrolled in research studies are better protected,” concluded IOM committee chair Daniel Feldman of Harvard Medical School.
Clinical trials are essential to medicine. Only when treatments and drugs can be compared among different groups of patients participating in a clinical trial can researchers discover what works and what doesn’t — or what’s safe and what isn’t. Major breakthroughs in medicine — from new surgical techniques to vaccines to potent drugs to combat AIDS — are now standard care because research volunteers took the risk to try them. In turn, research institutions are expected to fully inform patients of the risks and to protect them from foreseeable harm.
“No research effort is without at least some risk,” said Feldman when the IOM report was released. “But research should be done only with appropriate safeguards for participants, whose presence is indispensable to the progress that beckons all of us.”
The report was commissioned by HHS following the 1999 death of 18-year-old Jesse Gelsinger. The teen suffered from a relatively mild form of a genetic liver disease, which he controlled through diet. He volunteered to participate in a gene therapy trial at the University of Pennsylvania’s Institute for Human Gene Therapy in Philadelphia, solely to help find a cure for other children.
Despite several negative results using the same gene therapy on monkeys, researchers injected Jesse with massive doses of a genetically engineered virus. His vital organs failed within hours and he was dead four days later. When the National Institutes of Health reminded hospitals after Gelsinger’s death to advise the agency of problems with gene therapy, researchers reported nearly 700 adverse effects and seven deaths in similar trials.
The public and press would never look at clinical trials in quite the same way. “The Jesse Gelsinger case changed the universe,” says Alan Milstein, a New Jersey attorney who has filed lawsuits in several clinical-trial cases and won an undisclosed sum from the University of Pennsylvania for Gelsinger’s parents.
Conflict of interest was a major issue in the Gelsinger case, which illustrated that money isn’t always at the root of potential conflict in scientific research. Investigators can also be motivated by career advancement, fame or the drive to break new ground.
“Money wasn’t God” for James Wilson, the lead researcher in the Gelsinger case, says Milstein. “He was in it for the scientific discovery.” But the financial conflict wasn’t insignificant. Wilson, along with the University of Pennsylvania, held substantial stock in Genovo, a company Wilson founded to market the gene technique used in the Gelsinger clinical trial. When Genovo was purchased by Targeted Genetics Corp. a year after Gelsinger’s death, Wilson received $13.5 million in stock, and Penn got $1.4 million.
U.S. researchers currently conduct an estimated 80,000 clinical trials with 20 million participants annually. Precise participation numbers don’t exist. There’s no tally of people in research and no one tracks the totals of how many people are harmed — or helped — in studies each year.
People volunteer for clinical trials for a variety of reasons. Terminal patients grasp for anything that might prolong their lives. Some who enroll believe their participation will win special attention from their doctors.
Motivated patients can seek clinical trials online and track down hospitals and doctors that offer opportunities for participation in such trials.
More likely, patients are invited to participate in a trial when they arrive at their doctor’s office or hospital for treatment. The number of trials has soared in the last five years and competition for warm bodies is intense. Some doctors collect fees as high as $10,000 for each patient they enroll and retain in a clinical study.
“These fees are becoming an important, if not a main, segment of income for doctors, who are dealing with cost reductions by HMOs,” said Virginia Sharpe, a project director at the Center for Science in the Public Interest in Washington. “Companies who want their drugs tested welcome these physicians with open arms.”
Before the money incentives even kick in, researchers who also treat clinical subjects as patients face an inherent conflict of interest: They must weigh patient risk against the potential for a medical breakthrough. Should an individual’s health be sacrificed to new information if it means that thousands may be saved in the future? “Clinical trials aren’t intended to help patients,” says Sharpe. “They’re supposed to further scientific knowledge.”
Patients often don’t have a clue that these kind of conflicts exist. They tend to believe their doctor has only their best interest at heart, and informed-consent documents are often not worded clearly enough to overcome that preconception, say healthcare advocates.
“There’s a myth among patients that clinical trials are intended to help them,” says Milstein. “Patients always tend to see doctors as their doctor, while doctors may view them primarily as research subjects.”
Federal regulation requires the disclosure of financial conflicts of interest in federally funded research. But an estimated 80 percent of medical research is now privately financed and is not affected by the law. Universities and hospitals are free to design their own regulations concerning financial conflicts. A study in the Journal of the American Medical Association (JAMA) by Mildred Cho, the acting director of bioethics at Stanford University Medical Center, found that hospitals and universities have a “wide variation” on how they manage conflicts of interest and that many rules “lack specificity.” Few hospitals require conflict disclosures to patients.
Cho believes financial conflicts of interest should not be allowed unless a researcher can make a case for it. But she admits there’s little support in the medical community for such a view.
“Journalists and lawyers are trained to be aware of potential conflicts. Doctors are trained to believe they’re only concerned with the greater good,” says Cho. “As a profession, doctors and biomedical researchers don’t see themselves as anything other than advocates for patients. They bristle when you suggest another possibility.”
A revolutionary change in the relationship between academia and private enterprise occurred in 1980 when the Bayh-Dole act became law, allowing universities to patent government-funded research and to license their inventions to corporations. The result was an explosion of start-up companies by professors and marriages between major pharmaceutical corporations and university hospitals.
“It’s unclear if nonprofit institutions ever really benefited from the kind of income the bill intended,” Sharpe says. “What is certain is that it broke down the barriers between academic institutions and private enterprise by introducing many more financial arrangements between the two groups. Research is now predominantly market driven, making academic institutions essentially outposts of private corporations.”
Angell believes the law has turned academic medical centers into “little more than hired hands supplying human subjects and collecting the data.”
Health advocates are concerned about the effects of such relationships on study results. A 1998 report by the Inspector General’s office in HHS concluded last year that IRBs are “inundated with protocols and adverse-event reports,” and that many IRBs are “hard-pressed to give each review sufficient attention.”
The report proposes a number of changes in the system of clinical trials, including increasing the scrutiny by IRBs within federal oversight and improving the ethical training of researchers. It also recommends that participants be continually updated about the risks they face and that anyone harmed in clinical trials be financially compensated without being forced to resort to lawsuits. It urges that each study be examined by IRBs for scientific integrity as well by research ethics review panels (including community and participant representatives) for financial conflicts of interest.
Milstein praised the report. “It identifies the fact that this is a sick system. Sometimes that’s 90 percent of a solution,” he says.
But health watchdogs say the report sidesteps the elephant in the living room: what to do about financial conflicts of interest. “Managing financial conflicts of interest should lie with the research organization,” the report recommends. But Sharav of the Alliance for Human Research Protection insists: “You can’t manage conflict of interest. It has to be eliminated.”
Angell, who characterizes the IOM report as “pretty timid,” agrees. She believes all research on human subjects should be subjected to ethics supervision by bodies independent of the institutions conducting the research. “Current IRBs are creatures of the institutions they supervise, which have an interest in the research,” she says. She also wants an outright ban on financial conflicts. She believes that investigators who receive grant support from industry should have no other financial ties to those companies and that institutions should not be allowed to accept grants with strings attached. That means investigators should design their own studies, analyze the results, and write their own papers — without corporate manipulation or pressure.
A report also issued in October by the Association of American Medical Colleges takes a harder stance than IOM on financial conflicts. “The growing perception that research institutions may have financial conflicts of interest … threatens to weaken public support for research,” the report warns. It calls for a ban on most financial conflicts unless a compelling case can be made for an exception.
The current situation will change only if the public “becomes outraged,” says Angell. Academic institutions “are tax exempt because they’re supposed to be independent organizations, but they’re deep into financial deals with corporations. They can’t have it both ways. That’s creating widespread cynicism about the integrity of research and the outcomes. The public is going to begin to wonder what function these institutions are serving if they’re increasingly set up to make money.”
“These institutions talk about public trust the way a beer company talks about public trust,” she says. “You’ve got to be trustworthy to earn public trust. They want to get the trust without the trustworthy part.”
