The proposal to conduct an intimate examination of every indigenous minor in the Northern Territory will re-traumatise any that have been s-xually abused and potentially be very traumatic to the remainder of that entire population.

If the concern is with untreated s-xually transmitted infections, and the prevalence of these were demonstrated to be worryingly high, it would do less damage and probably result in greater coverage of the target group if all children were treated with appropriate antibiotics, without preliminary examination.

But, as it has been described in news reports, the proposed strategy appears to be at least as much about conducting a witch-hunt for abusing adults as it is motivated by concern for the physical health of the children. Yet, it is a basic rule of whole-of-population screening that the initial test must be sensitive, specific and reliable (witness the scandal several years ago regarding anal tears as evidence of s-xual abuse in children in the UK), and that it should be coupled to confirmatory testing to secure positive diagnoses AND to effective intervention to interrupt the natural history in proven cases.

Presumably the ‘confirmatory testing’ in John Howard’s plan would be a legal process – haven’t Indigenous people had enough done to them at the hands of whitefella police and courts? – and what might be an effective intervention for proven cases of abuse, other than protracted incarceration for convicted adults, is very far from clear.

Thus, even the most basic public health analysis very quickly shows that the Howard plan to screen every Indigenous child is bound to be a failure, if not also fail the test of non-maleficence. But then every medical student knows that the knee-jerk is a spinal reflex; stimulus is followed by an automatic response that lacks any modulation by the higher cerebral centres.

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Peter Fray
Peter Fray
Editor-in-chief of Crikey
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