An Interesting Situation: Repudiation or Retraction?

An interesting situation is unfolding in the blogosphere (and I assume, eventually the news) today which I wanted to bring to my colleagues’ attention–and I hope, generate some discussion. It’s a question of words and perhaps semantics but I think in this case, the words have a great deal of meaning as well as repercussions for science now and into the future. A recap of the situation:

In 2001, Robert Spitzer, MD, conducted structured interviews with 200 participants who had undergone some form of “reparative therapy,” which is the name for the theory that  homosexual sexual orientation can be changed by psychotherapy. He published his findings in 2003 in The Archives of Sexual Behavior, a peer reviewed journal that is the official publication of the International Academy of Sex Research. (For anyone who is curious, it has an impact factor of 3.66).

Since the publication of this paper, many “ex-gay” organizations, such as Focus on the Family and PFOX (Parents and Friends of Ex-Gays and Gays) have touted Spitzer’s findings as “proof” that sexual orientation can be changed permanently. Spitzer has long claimed that this is a misinterpretation of his findings and has tried to distance himself from these groups. (I think it is worth noting that Spitzer led the 1973 effort to declassify homosexuality as a mental illness.)

Today (April 11, 2012) The American Prospect published a lengthy article by Gabriel Arana, a man who himself had undergone “reparative therapy” in the late 1990s. Titled “My So-Called Ex-Gay Life,” the article promises (and delivers) “a deep look at the fringe movement that just lost its only shred of scientific support.”

In the article, Arana includes an interview with Spitzer, asking him about his research from 2001. As part of the conversation, Arana writes:

Spitzer was drawn to the topic of ex-gay therapy because it was controversial—“I was always attracted to controversy”—but was troubled by how the study was received. He did not want to suggest that gay people should pursue ex-gay therapy. His goal was to determine whether the counterfactual—the claim that no one had ever changed his or her sexual orientation through therapy—was true.

I asked about the criticisms leveled at him. “In retrospect, I have to admit I think the critiques are largely correct,” he said. “The findings can be considered evidence for what those who have undergone ex-gay therapy say about it, but nothing more.” He said he spoke with the editor of the Archives of Sexual Behavior about writing a retraction, but the editor declined. (Repeated attempts to contact the journal went unanswered.)

Spitzer said that he was proud of having been instrumental in removing homosexuality from the list of mental disorders. Now 80 and retired, he was afraid that the 2001 study would tarnish his legacy and perhaps hurt others. He said that failed attempts to rid oneself of homosexual attractions “can be quite harmful.” He has, though, no doubts about the 1973 fight over the classification of homosexuality.

At the conclusion of the section with Spitzer’s interview, comes this comment:

Spitzer was growing tired and asked how many more questions I had. Nothing, I responded, unless you have something to add.

He did. Would I print a retraction of his 2001 study, “so I don’t have to worry about it anymore”?

This last statement is what has the blogosphere hopping. Towleroad, Good As You, AmericaBlog, and Truth Wins Out have all reported on the “retraction.” Now let me go on record as saying that I am delighted with this turn of events and the fact that Dr. Spitzer has declared publicly that he no longer stands behind his findings. But (and maybe I am splitting hairs here, but I don’t think so), this isn’t a retraction, it’s a repudiation. A retraction would need to occur with action by the journal editor and/or the International Academy of Sex Research. Until that happens, the article will continue to be indexed at various sites, including MEDLINE, with no indication that the author no longer supports his work.

Note that if the article is retracted, this information will be included with the original citation. The picture below is an example from a recent high-profile retraction from Lancet.

A question that comes to mind (and one I would like to discuss) is when does an editor take action? Note that in Arana’s article, Spitzer says he contacted the editor about a retraction but that “the editor declined.” Certainly, as an editor, a retraction is a very serious step and not one that is taken lightly. I can understand why an editor might be reluctant to take action based on a request from an author.

However, what I think what is interesting about this case, and a bit of a different twist from retracted articles that I have read about in the past, is that in this situation it is the author who no longer supports his work. I think more commonly, the issue comes to light through an investigation of scientific misconduct, falsification of data, fraudulent findings and so on. Indeed, Andrew Wakefield, author of the retracted Lancet article continues to maintain that his research was sound and that there was no evidence of a hoax or fraud.

Even though the editor of The Archives of Sexual Behavior  made an initial decision, should he do something now? If so, what? One option is to let the article stand–take no action as originally intended. The case could be made that the paper went through the usual peer review process and was found to be sound–what has changed is that the findings are no longer relevant, particularly in light of the author’s change of heart. I am sure it wouldn’t take much digging to find many examples of studies that have been previously published and are not longer accurate or meaningful. Are people taking steps to retract those papers? I don’t think so.

On the other hand, if the journal takes no official action, how are others to learn of the repudiation of the work? While it remains in the extant body of literature, it can be cited, quoted, and put forth as evidence that “reparative therapy” should be considered as an intervention for those persons who are uncomfortable with their sexual identity. Organizations such as those mentioned earlier are free to leave the citation on their websites and in their literature. Is this ethically defensible?

Writing this has helped me clarify in my mind what I would do as an editor: retract the paper given the circumstances. But I welcome discussion from my colleagues because I think this is an important, timely, ethical, and complex issue and I am interested in  viewpoints other than mine. I look forward to  your comments.

Citation: Spitzer RL. Can some gay men and lesbians change their sexual orientation? 200 participants reporting a change from homosexual to heterosexual orientation. Arch Sex Behav. 2003 Oct;32(5):403-17; discussion 419-72. PubMed PMID: 14567650.

14 thoughts on “An Interesting Situation: Repudiation or Retraction?

  1. Thank you for this very informative and thoughtful post, Leslie. This is an issue that I expect to become more and more prominent, since authors and readers have such ready access to discussion and exposure online of responses to published article. I definitely would retract this article if it had been published in ANS. I would hope that readers would send letters to the editor raising questions and objections to an article that is published, and my first action would be to request a response from the author. However, in the case you describe, it seems that the author did not repudiate his research until much later after it was published, which would create a different situation. But if at any time an author were to contact me repudiating their earlier work, and request a retraction, I believe this is ample justification to retract.

    There is another remedy that you hint at here … subsequent research and evidence around a given topic could eventually render earlier work questionable or invalid. Scholars who are building on literature in the field would be expected to follow the trail of evidence, and would be obligated to use the best evidence available from current literature, recognizing issues that might appear in earlier works that might have seemed acceptable. However, in this case, the issue has tremendous social and political consequences, and the people who are using the earlier work to support their damaging claims are not scholars — they are folks invested in spinning a narrative to support their limited (and damaging) views on the issue. When an author, who originally saw his or her work as valid, but who later comes to realize (partly because of other work that challenges the earlier work) comes forward to acknowledge their own error, or misguided assumptions — that is a huge act of integrity and courage, and one that deserves our respect. This particular case is politically loaded and therefore particularly important to attend to. But even if the issue at hand was one that did not have this kind of political context, I believe the author’s request to retract should be honored.

    I will be interested in hearing from others!

    • Thank you, Peggy, for this comment.

      Since writing this post I’ve done a little bit more research and is so often the case, there is much more to this story than meets the eye. Spitzer presented preliminary findings of the study at the APA conference in 2001. Kenneth Zucker, PhD, is the editor of The Archives of Sexual Behavior; he had become editor in 2002 and is still presently in the position. In an accompanying editorial in the October 2003 issue, he described Spitzer’s paper as “an invited target article.” He further wrote, “Because of the nature of the study, the editor was of the view that it should only be published with detailed peer commentary, along with a reply by the author.” He states that the article went through “several revisions” but he is not explicit if it was peer reviewed. The article was published along with 26 commentaries comprising 53 pages. In 2006, Zucker, along with Jack Drescher edited Ex-Gay Research: Analyzing the Spitzer Study And Its Relation to Science, Religion, Politics, and Culture, which seems to be a book that consists of the all the original material from the October 2003 issue of The Archives of Sexual Behavior as well as new content written for the book and an interview with Dr. Spitzer.

      So, I guess this begs the question, “Is the article retractable?” When you have an article that has spawned a “cottage industry” of commentary, much of it intentionally spurred on by the editor, who obviously realized then, as now that this is a controversial issue, can you “retract” an article that is the centerpiece of so much discussion?

      I think your point is very well taken that this article does have tremendous social and political consequences and is being misused by non-scholars who have a specific agenda. How does one remove something like this from the public discourse? How does an author effectively repudiate his work? And what is the editor’s role in all of this? These are the questions that are bouncing around in my head now.

      Like you, I look forward to hearing from others!

      Citation: Zucker KJ. The politics and science of “reparative therapy”. Arch Sex Behav. 2003 Oct;32(5):399-402. Review. PubMed PMID: 14567649.

  2. I leave the question of retraction to the editors, but am more concerned about the study. Here is the key statement, in my view, about the study:

    “His goal was to determine whether the counterfactual—the claim that no one had ever changed his or her sexual orientation through therapy—was true.”

    Why do a study from this standpoint? This is an example of a situation in which the researcher needed to consider the ethical ramifications of looking for a case to falsify the claim that sexual orientation was not changeable, in fact reversible, through therapy. There are dozens of cases in which a single individual attests to having been “corrected” via christian conversion, etc. The science of human behavior is inexact to say the least.. Who benefits from the findings of the study? One should consider the political fallout from a study that has a goal of falsification of a a claim having to do with human behavior that would add to the suffering of an oppressed group. The timing of such a study looks like the point was to add to the chaos, under the auspices of resolving a controversy. Evidence of genetic influence in sexual orientation is accumulating. The literature as a whole supports that sexual orienttation is determined early on. In any case of human behavioral intervention, such as a form of therapy, the tenets of probablility underscore that there might be a very small number of cases whhere the feat of change is “accomplished.” How long does this “repair” last? The researcher’s motive reminds me of “armchair interest” in a question, detached from the political context of the controversy. I think mmaybe he has to live with that decision, as a scientist. The retraction might be in order, if the study is still being cited regularly, not for his sake, but to clear the air, especially for the general audience.

    • Well, my knee-jerk reaction was that the article HAD to be retracted because it was not only just wrong but also because it has – and will continue to – cause harm. It is unfortunate that, in an attempt to determine if an event CAN happen – however rarely, is taken by individuals without scruples to tout that it SHOULD happen. Not everyone who is homosexual is “uncomfortable with their sexual identity.” I know I work in a unique area (HIV), but my experience (VERY unscientific, of course) leads me to believe that people who are accepted as individuals, encouraged to embrace their own identities, and provided with accepting environments will be comfortable with whatever sexual identity emerges. WIll they question? Probably – many of us do. But the likelihood of ending up “uncomfortable” is drastically reduced.

      HOWEVER, that is not the question that Leslie asked. Should the article be retracted? Another (stronger) knee-jerk: Yes! Not only should it be retracted, the journal should publish a special issue dedicated to a discussion about WHY it was retracted including articles with updated and better research to reveal the limitations of the original study and commentaries about the harm that has been done.

      And then I had a moment of lucidity and I asked myself, what if the article in question had been on any other topic? What if the problem in the research was caused by a specious but long held assumption about the topic/community/process being studied? As Peggy pointed out, further research can refute earlier findings and the literature will begin to correct the problem. It takes time, and harm can be done as the corrections emerge, but the system usually works. For instance, I can remember dosing AZT every 4 hours around the clock – a horrible regimen that only the most committed patient could hope to adhere to – because research showed that AZT had a short half life. More research proved that q4h was not required; more research found better drugs; more research showed the problems of monotherapy; more research . . . etc. We didn’t know and we didn’t have the resources to know, but we did the best we could with the evidence at hand.

      So my questions are: Do we make decisions about retractions (vs. letters to the editor repudiating the article vs. printing better research) based on the topic of that article? Do we make decisions based on harm done and the potential for harm – i.e., how the article has been misinterpreted and used for “evil”? and whose “evil” is it anyway – yours or mine? Should discussions such as these be limited to social issues (as opposed to bench science)? Do we make decisions based on how old the article is and whether or not additional evidence has been published that moves us past earlier ill-conceived studies? And . . . there are so many more questions that it boggles my mind. I have to go back to one of my prime directives: Context Counts. And the context of this issue is very different from the context of AZT’s half life 2 decades ago.

      What a great blog topic – thanks Leslie!!!

      • Thank you, Lucy, and thanks for your comment and great examples. This has given me much to think about for the past 24 hours.

  3. The question is well worded. WHEN does an editor take action? The suppositions about whether one would or would not retract the article are moot in the scenario as presented because “in Arana’s article, Spitzer says he contacted the editor about a retraction but that ‘the editor declined.'” That editor does owe it to the scientific community to publish a commentary explaining the reasons for the refusal. Perhaps best, it could be published alongside a letter from Spitzer explaining his reasons for the requested retraction. Then the dialog about this situation is in the literature, as is the original article.
    To get back to your question about WHEN to act: The scenario seems to me almost more akin to full disclosure about financial funding for scientific research. Immediately after being approached by Spitzer, the editor should have published a statement explaining that she or he was approached about retraction and why the request was refused. As it is now, it looks like she or he was hiding something from the scientific community.

  4. We may not have all the facts in this case, but based on the COPE guidelines for retractions (copied below) the editor should consider publising an “expression of concern.” The editor is on record as stating he does not know what the author wants to retract because there is no question of fabricated data, but “honest error” may be a legitimate reason for retraction in this case.

    “Journal editors should consider retracting a publication if:
    • they have clear evidence that the findings are unreliable, either as a result of misconduct (e.g. data fabrication) or honest error (e.g. miscalculation or experimental error)
    • the findings have previously been published elsewhere without proper crossreferencing, permission or justification (i.e. cases of redundant publication)
    • it constitutes plagiarism
    • it reports unethical research
    Journal editors should consider issuing an expression of concern if:
    • they receive inconclusive evidence of research or publication misconduct by the authors
    • there is evidence that the findings are unreliable but the authors’ institution will not investigate the case
    • they believe that an investigation into alleged misconduct related to the publication either has not been, or would not be, fair and impartial or conclusive
    • an investigation is underway but a judgement will not be available for a considerable time”

    • I don’t think “honest error (e.g. miscalculation or experimental error)” would fit here as a basis for retraction. Spitzer has changed his mind about how to interpret the data. (If the guidelines covered errors in judgment—now, that might be a different matter…)

      From the link that Alice posted earlier, it seems that Spitzer’s retraction request to the Annals of Sexual Behavior came in the midst of a telephone conversation with the editor on another topic. As far as his “request” for The American Prospect to print a retraction—Spitzer really couldn’t have expected The American Prospect to print a retraction of something published in Annals of Sexual Behavior.

      At any rate, it appears that the Annals editor has indicated that he will print a letter from Spitzer if he receives one. That sounds like a sensible approach. Clearly, Spitzer now has regrets about what he published. He should be able to say so in print (and why). And journal readers should be made aware of his reevaluation of his findings.

      There are some other questions posed by this repudiation/retraction/renunciation/regret. (I guess whatever we should call it, at least we know it starts with an “r”). I recently posted something about its context/significance on another blog. I won’t repeat myself here, but the link is:

      http://centerforhealthmediapolicy.com/2012/04/14/shutting-the-door-on-reparative-therapy-2/

  5. Pingback: Shutting the Door on “Reparative Therapy” « CHMP

  6. Hmmm. As an academic reference librarian who also follows gay rights politically, I have a few thoughts. First, I see nothing wrong with Spitzer’s curiosity to prove or disprove the counterfactual. I think it’s safe to say that both gay rights supporters and our opponents would like to simplify reality to fit our political needs.

    By this I mean that if you speak to almost any human being at some length about their sexuality, you’ll find that it doesn’t fit into a neat box. Desire, fantasy, and actions do not align 100% for most people. We are human beings, we have complex minds. Gay rights opponents make the claim that all human beings are naturally heterosexual which leaves gay rights supporters stuck making the argument that gay people are naturally gay.

    Given the nature of this debate, which to my mind is about all of the wrong things, the issue of whether anyone ever chooses their sexual orientation is certainly a reasonable area of scientific inquiry. It was a reasonable study to do and everyone seems to agree that Spitzer’s methods were also reasonable. So, what does he want to retract? His interpretation of the data? The general public’s understanding of the data? The way the data has been used politically?

    If he has something to say on the topic, by all means, he should publish it. When people do ground-breaking research, it is common for them to reach a preliminary conclusion. The idea is that there will be future studies on that topic, that the data will develop, that we will learn more.

    We are now about 10 years out from the original study and I’m sure there has been more work on the topic. If Spitzer feels that new data suggest that his interpretation was wrong, by all means, he should publicly clarify his thinking.

    On the other hand, if he feels that both the data and the interpretation are still valid, but that it has been misunderstood or misapplied by the general public, he should publish a different kind of article entirely. I’m sure the New York Times would be happy to grant that interview.

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