New Nursing Journal!

We are delighted to announce the launch of a new Nursing Journal – Asian/Pacific Island Nursing Journal!  The Editor is Jillian Inouye, PhD, APRN, FAAN, who is on the faculty of inouye-jillianNursing at the University of Nevada Las Vegas.  Jillian has also joined our own planning group for the 2015 INANE conference, which will be held in Las Vegas and is being hosted by Carolyn Yucha, Editor of Biological Research for Nursing.  Please join me in welcoming Jillian and this new nursing journal to INANE!

Here is the listing for this journal that now appears in the Directory of Nursing Journals

Asian/Pacific Island Nursing Journal

  • Editor: Jillian Inouye
  • Publisher: Sage Publications
  • Association: Asian American/Pacific Islander Nurses Association (AAPINA)
  • Author Guidelines
  • Description: Created to fill the gap between nursing science and behavioral and social sciences, Asian/Pacific Island Nursing (APN) offers a forum for empirical, theoretical and methodological issues related to API ethnic, cultural values and beliefs and biological and physiological phenomena that can affect nursing care.

Mental Illness: My Personal Experience, Our Professional Responsibility

Ed note: Our INANE colleague, Francie Likis, wrote this editorial for the March/April issue of the Journal of Midwifery & Women’s Health. I am grateful for her willingness to share it here.

Frances E. Likis CNM, NP, DrPH, FACNM, FAAN

cover (1)I was 17 years old the first time I was hospitalized for mental illness. After that, I spent more than a dozen years on a roller coaster of getting better and getting worse. I dropped into and out of care depending on how poorly or well I felt. I was willing to take medications or seek therapy when my symptoms interfered with my life, but I stopped them when I felt better. Finally, in my early 30s, I accepted the fact that having bipolar disorder is a chronic condition for which I will need medication for the rest of my life.

The next 10 years were more stable than the years that preceded them. I took my medication every single day. I tried to get adequate exercise and sleep, both of which help me feel better. That isn’t to say it was always smooth sailing. I had episodes that required adjusting the dosage of my primary medication and, at times, adding additional medications. But overall, my bipolar disorder was fairly well controlled.

Last spring, without warning, everything changed. I had a severe depressive episode. I had forgotten how consuming and awful depression is. I was constantly exhausted; it could take hours of napping to recover from a short period of activity. My brain felt like mud. I could not think or concentrate. I did things that I usually would enjoy, that I wanted to enjoy, but I found no pleasure in them. I cried for no reason. There are no words to adequately convey the horrific and overpowering darkness of depression.

In addition to feeling terrible, I was terrified. I had convinced myself that as long as I took my medication and went to my psychiatrist regularly, I would never be that sick again. But it happened anyway, and it was frightening. I was even more frightened that I would not recover. I relentlessly repeated a mantra in my head, “You have gotten better before, you will get better again,” as if my life depended on it. And it may well have. After a few months, with the help of new medication and cognitive-behavioral therapy, I did get better. I also benefitted from a great deal of love, support, faith, and grace.

During this time, I was often so sick and tired that I didn’t have the energy to put on a good face and conceal my illness, as I had in the past. While most of my close friends knew I had bipolar disorder, I had never been completely open about it beyond my inner circle. This time, when people asked why I wasn’t myself, I told them what was wrong. While many were empathetic, others commented, “Why are you depressed when you have so much in life going for you?” or “You just need to get up and out, go exercise, think positively, etc.” I know they didn’t mean to be hurtful, but their comments reflect a lack of understanding of mental illness that is pervasive.

As I began to feel better, I felt a strong need to be more public about having bipolar disorder. I was frustrated that there are still so many misconceptions about mental illness. I was reminded, yet again, that I have been one of the fortunate ones. Frequently I see individuals who are obviously mentally ill, and I know how thin the line is between me and them, and how much of that line is simply luck. I have always had health insurance and thus the ability to access care and get treatment. I have found medications that work for me as well as wonderful physicians and therapists. I have loving and supportive family and friends.

Last June, a close friend of my sister and her husband committed suicide after a long battle with mental illness. When my sister called to tell me, I told her how sad I was that we don’t have better treatments for mental illness in this country. She told me how mad she was that mental illness is so misunderstood and uncomfortable that we are often unwilling to discuss it. One of our friends referred to mental illness as a fatal disease; indeed, one-third of individuals with bipolar disorder attempt suicide.[1] Suddenly the idea of an editorial as testimony and a call to action was no longer optional, it was imperative. I wrote my first draft last August and have spent the months since deciding whether to publish it. I have had lengthy conversations with family and friends about the implications for my personal and professional life. Throughout this time, I have had repeated signs and increasing conviction that it is the right thing to do.

Why do I feel compelled to tell my story in this public and professional forum? First, I want to fight back against the stigma and fear that surround mental illness. Believing mental illness is shameful and should be kept a secret has to stop. People are not embarrassed or reluctant to say they have diabetes or hypertension or other common health conditions. I want to acknowledge and share my story.

Second, I stand to remind you that mental illness is widespread and the faces of those who are affected are not always the faces you might expect. I have a successful career and a life filled with family and friends, and I have a serious mental illness. And my face is only one of the millions of people in the United States experiencing mental illness. One-fifth of adults in the United States have a diagnosable mental illness in a given year, and 5% of US adults suffer from a serious mental illness that substantially interferes with or limits their life activities.[2]

Finally, I want to call my fellow midwives and other health care providers to action. More than half of US adults with mental illness are not getting mental health care.[2] As clinicians, we have a duty to ensure mental illness is recognized, accurately diagnosed, and treated. When women we care for have mental health needs beyond our expertise, we must help them access the care and resources they require. We have to educate patients and their loved ones that mental illness can be severe and even life-threatening. We can help remove the fear and shame about mental illness and increase understanding that mental illness is another health condition and not a special category. Each year, May is observed as Mental Health Month in the United States. This May and beyond, I hope my personal experience will encourage all of us to consider our responsibility in identifying and helping those who are suffering from mental illness.

REFERENCES

1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Arlington, VA: American Psychiatric Association; 2013.

2. Substance Abuse and Mental Health Services Administration. Results from the 2010 National Survey on Drug Use and Health: Mental Health Findings. NSDUH Series H-42. HHS Publication No. (SMA) 11–4667. Rockville, MD: Substance Abuse and Mental Health Services Administration; 2012.

Election of COPE Council Members, January 2014

INANE is fortunate to have two nurse editor members on the COPE (Committee on Publication Ethics) Council–Charon Pierson and Geri Pearson. Geri is running for re-election this year. In her words,

 I finally seem to understand the workings of this complex organization and can continue to contribute the Council for nursing editors. I am requesting that all those whose journals have COPE membership consider voting for me.  I’ve been told by leadership that every vote counts in this election.

Here is Geri’s personal statement for re-election:

When I became involved with COPE nearly four years ago I had no idea that my eventual election to the COPE Council would open so many doors to knowledge about publication ethics, a world view of the dilemmas faced by editors, and a sense of the growing complexity around ethics and publications. I have been very active on the COPE Council, reviewing cases, attending meeting and forums, and participating in planning conferences and events. I developed a systematic checklist system for COPE presentations, workshops, and forums.  This appears to be useful as it has been implemented over the past year. COPE is becoming increasingly visible in the world and I’m proud to be a part of an organization that implements the ethical principles it represents. I hope that I can have the chance to further my involvement with COPE with election to a second 3-year term.

Click here to learn more and vote in this year’s election. Note that voting closes on January 24, 2014.

Not the Answer — An Academic Carefully Assesses the Arguments for Open Access

Leslie:

Very interesting…wanted to share with INANE members. Leslie

Originally posted on The Scholarly Kitchen:

Trespassing

Trespassing (Photo credits: http://www.mysecuritysign.com)

I recently finished reading a long essay by Daniel Allington, a sociologist, linguist, and book historian living in the UK. He’s been following the debates about open access (OA) in the UK quite closely, and has written a well-informed piece detailing the hopes, limitations, and mandates associated with OA. The essay, entitled, “On open access, and why it’s not the answer,” brings a very careful analytical style to the proceedings, something that we encounter too infrequently, I believe.

His conclusion? OA is not the solution, partially because advocates can’t agree on the problem to be solved, partially because the economics of the OA solution shift financing but don’t solve the basic economic problems of science publishing, partially because OA seems far too disruptive for the purported benefits, and partially because the route to accessibility is only slightly dependent on economics but significantly dependent on…

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Closing the Loop on Dr. Spitzer

I posted here more than three weeks ago about the letter Dr. Robert Spitzer sent to Dr. Kenneth Zucker, repudiating and apologizing for his 2003 publication on “reparative therapy” for gays. Rachel Maddow did a great piece on it, blogs were all a-twitter (although it’s been a few weeks so they’ve gone quiet) and now, finally, the New York Times has picked up the story.

Leading Psychiatrist Apologizes for Study Supporting Gay ‘Cure’

By BENEDICT CAREY

Dr. Robert L. Spitzer

PRINCETON, N.J. — The simple fact was that he had done something wrong, and at the end of a long and revolutionary career it didn’t matter how often he’d been right, how powerful he once was, or what it would mean for his legacy.

Dr. Robert L. Spitzer, considered by some to be the father of modern psychiatry, who turns 80 next week, lay awake at 4 o’clock on a recent morning knowing he had to do the one thing that comes least naturally to him.

He pushed himself up and staggered into the dark. His desk seemed impossibly far away; Dr. Spitzer suffers from Parkinson’s disease and has trouble walking, sitting, even holding his head upright.

The word he sometimes uses to describe these limitations — pathetic — is the same one that for decades he wielded like an ax to strike down dumb ideas, empty theorizing, and junk studies.

Now here he was at his computer, ready to recant a study he had done himself, a poorly conceived 2003 investigation that supported the use of so-called reparative therapy to “cure” homosexuality for people strongly motivated to change.

What to say? The issue of gay marriage was rocking national politics yet again. The California State Legislature was debating a bill to ban the therapy outright as being dangerous. A magazine writer who had been through the therapy as a teenager recently visited his house, to explain how miserably disorienting the experience was.

And he would learn later that a World Health Organization report, released on Thursday, calls the therapy “a serious threat to the health and well-being — even the lives — of affected people.”

Dr. Spitzer’s fingers jerked over the keys, unreliably, as if choking on the words. And then it was done: a short letter to be published this month, in the same journal where the original study appeared.

“I believe,” it concludes, “I owe the gay community an apology.”

Disturber of the Peace

The idea to study reparative therapy at all was pure Spitzer, say those who know him, an effort to stick a finger in the eye of an orthodoxy that he himself had helped establish.

In the late 1990s as today, the psychiatric establishment considered the therapy to be a nonstarter. Few therapists thought of homosexuality as a disorder.

It was not always so. Up into the 1970s, the field’s diagnostic manual classified homosexuality as an illness, calling it a “sociopathic personality disturbance.” Many therapists offered treatment, including Freudian analysts who dominated the field at the time.

Advocates for gay people objected furiously, and in 1970, one year after the landmark Stonewall protests to stop police raids at a New York bar, a team of gay rights protesters heckled a meeting of behavioral therapists in New York to discuss the topic. The meeting broke up, but not before a young Columbia University professor sat down with the protesters to hear their case.

“I’ve always been drawn to controversy, and what I was hearing made sense,” said Dr. Spitzer, in an interview at his Princeton home last week. “And I began to think, well, if it is a mental disorder, then what makes it one?”

He compared homosexuality with other conditions defined as disorders, like depressionand alcohol dependence, and saw immediately that the latter caused marked distress or impairment, while homosexuality often did not.

He also saw an opportunity to do something about it. Dr. Spitzer was then a junior member of on an American Psychiatric Association committee helping to rewrite the field’s diagnostic manual, and he promptly organized a symposium to discuss the place of homosexuality.

That kicked off a series of bitter debates, pitting Dr. Spitzer against a pair of influential senior psychiatrists who would not budge. In the end, the psychiatric association in 1973 sided with Dr. Spitzer, deciding to drop homosexuality from its manual and replace it with his alternative, “sexual orientation disturbance,” to identify people whose sexual orientation, gay or straight, caused them distress.

The arcane language notwithstanding, homosexuality was no longer a “disorder.” Dr. Spitzer achieved a civil rights breakthrough in record time.

“I wouldn’t say that Robert Spitzer became a household name among the broader gay movement, but the declassification of homosexuality was widely celebrated as a victory,” said Ronald Bayer of the Center for the History and Ethics of Public Health at Columbia. “ ‘Sick No More’ was a headline in some gay newspapers.”

Partly as a result, Dr. Spitzer took charge of the task of updating the diagnostic manual. Together with a colleague, Dr. Janet Williams, now his wife, he set to work. To an extent that is still not widely appreciated, his thinking about this one issue — homosexuality — drove a broader reconsideration of what mental illness is, of where to draw the line between normal and not.

The new manual, a 567-page doorstop released in 1980, became an unlikely best seller, here and abroad. It instantly set the standard for future psychiatry manuals, and elevated its principal architect, then nearing 50, to the pinnacle of his field.

He was the keeper of the book, part headmaster, part ambassador, and part ornery cleric, growling over the phone at scientists, journalists, or policy makers he thought were out of order. He took to the role as if born to it, colleagues say, helping to bring order to a historically chaotic corner of science.

But power was its own kind of confinement. Dr. Spitzer could still disturb the peace, all right, but no longer from the flanks, as a rebel. Now he was the establishment. And in the late 1990s, friends say, he remained restless as ever, eager to challenge common assumptions.

That’s when he ran into another group of protesters, at the psychiatric association’s annual meeting in 1999: self-described ex-gays. Like the homosexual protesters in 1973, they too were outraged that psychiatry was denying their experience — and any therapy that might help.

Reparative Therapy

Reparative therapy, sometimes called “sexual reorientation” or “conversion” therapy, is rooted in Freud’s idea that people are born bisexual and can move along a continuum from one end to the other. Some therapists never let go of the theory, and one of Dr. Spitzer’s main rivals in the 1973 debate, Dr. Charles W. Socarides, founded an organization called the National Association for Research and Therapy of Homosexuality, or Narth, in Southern California, to promote it.

By 1998, Narth had formed alliances with socially conservative advocacy groups and together they began an aggressive campaign, taking out full-page ads in major newspaper trumpeting success stories.

“People with a shared worldview basically came together and created their own set of experts to offer alternative policy views,” said Dr. Jack Drescher, a psychiatrist in New York and co-editor of “Ex-Gay Research: Analyzing the Spitzer Study and Its Relation to Science, Religion, Politics, and Culture.”

To Dr. Spitzer, the scientific question was at least worth asking: What was the effect of the therapy, if any? Previous studies had been biased and inconclusive. “People at the time did say to me, ‘Bob, you’re messing with your career, don’t do it,’ ” Dr. Spitzer said. “But I just didn’t feel vulnerable.”

He recruited 200 men and women, from the centers that were performing the therapy, including Exodus International, based in Florida, and Narth. He interviewed each in depth over the phone, asking about their sexual urges, feelings and behaviors before and after having the therapy, rating the answers on a scale.

He then compared the scores on this questionnaire, before and after therapy. “The majority of participants gave reports of change from a predominantly or exclusively homosexual orientation before therapy to a predominantly or exclusively heterosexual orientation in the past year,” his paper concluded.

The study — presented at a psychiatry meeting in 2001, before publication — immediately created a sensation, and ex-gay groups seized on it as solid evidence for their case. This was Dr. Spitzer, after all, the man who single-handedly removed homosexuality from the manual of mental disorders. No one could accuse him of bias.

But gay leaders accused him of betrayal, and they had their reasons.

The study had serious problems. It was based on what people remembered feeling years before — an often fuzzy record. It included some ex-gay advocates, who were politically active. And it did not test any particular therapy; only half of the participants engaged with a therapist at all, while the others worked with pastoral counselors, or in independent Bible study.

Several colleagues tried to stop the study in its tracks, and urged him not to publish it, Dr. Spitzer said.

Yet, heavily invested after all the work, he turned to a friend and former collaborator, Dr. Kenneth J. Zucker, psychologist in chief at the Center for Addiction and Mental Health in Toronto and editor of the Archives of Sexual Behavior, another influential journal.

“I knew Bob and the quality of his work, and I agreed to publish it,” Dr. Zucker said in an interview last week. The paper did not go through the usual peer-review process, in which unnamed experts critique a manuscript before publication. “But I told him I would do it only if I also published commentaries” of response from other scientists to accompany the study, Dr. Zucker said.

Those commentaries, with a few exceptions, were merciless. One cited the Nuremberg Code of ethics to denounce the study as not only flawed but morally wrong. “We fear the repercussions of this study, including an increase in suffering, prejudice, and discrimination,” concluded a group of 15 researchers at the New York State Psychiatric Institute, where Dr. Spitzer was affiliated.

Dr. Spitzer in no way implied in the study that being gay was a choice, or that it was possible for anyone who wanted to change to do so in therapy. But that didn’t stop socially conservative groups from citing the paper in support of just those points, according to Wayne Besen, executive director of Truth Wins Out, a nonprofit group that fights antigay bias.

On one occasion, a politician in Finland held up the study in Parliament to argue against civil unions, according to Dr. Drescher.

“It needs to be said that when this study was misused for political purposes to say that gays should be cured — as it was, many times — Bob responded immediately, to correct misperceptions,” said Dr. Drescher, who is gay.

But Dr. Spitzer could not control how his study was interpreted by everyone, and he could not erase the biggest scientific flaw of them all, roundly attacked in many of the commentaries: Simply asking people whether they have changed is no evidence at all of real change. People lie, to themselves and others. They continually change their stories, to suit their needs and moods.

By almost any measure, in short, the study failed the test of scientific rigor that Dr. Spitzer himself was so instrumental in enforcing for so many years.

“As I read these commentaries, I knew this was a problem, a big problem, and one I couldn’t answer,” Dr. Spitzer said. “How do you know someone has really changed?”

Letting Go

It took 11 years for him to admit it publicly.

At first he clung to the idea that the study was exploratory, an attempt to prompt scientists to think twice about dismissing the therapy outright. Then he took refuge in the position that the study was focused less on the effectiveness of the therapy and more on how people engaging in it described changes in sexual orientation.

“Not a very interesting question,” he said. “But for a long time I thought maybe I wouldn’t have to face the bigger problem, about measuring change.”

After retiring in 2003, he remained active on many fronts, but the reparative study remained a staple of the culture wars and a personal regret that wouldn’t leave him be. The Parkinson’s symptoms have worsened in the past year, exhausting him mentally as well as physically, making it still harder to fight back pangs of remorse.

And one day in March, Dr. Spitzer entertained a visitor. Gabriel Arana, a journalist at the magazine The American Prospect, interviewed Dr. Spitzer about the reparative therapy study. This was not just any interview; Mr. Arana went through reparative therapy himself as a teenager, and his therapist had recruited the young man for Dr. Spitzer’s study (Mr. Arana did not participate).

“I asked him about all his critics, and he just came out and said, ‘I think they’re largely correct,’ ” said Mr. Arana, who wrote about his own experience last month. Mr. Arana said that reparative therapy ultimately delayed his self-acceptance as a gay man and induced thoughts of suicide. “But at the time I was recruited for the Spitzer study, I was referred as a success story. I would have said I was making progress.”

That did it. The study that seemed at the time a mere footnote to a large life was growing into a chapter. And it needed a proper ending — a strong correction, directly from its author, not a journalist or colleague.

A draft of the letter has already leaked online and has been reported.

“You know, it’s the only regret I have; the only professional one,” Dr. Spitzer said of the study, near the end of a long interview. “And I think, in the history of psychiatry, I don’t know that I’ve ever seen a scientist write a letter saying that the data were all there but were totally misinterpreted. Who admitted that and who apologized to his readers.”

He looked away and back again, his big eyes blurring with emotion. “That’s something, don’t you think?”

Click here to read the original article. I would also suggest perusing the comments. They are very interesting (and if you dig deep enough, you will find one from “you know who”). I am surprised at how many people have absolute faith in the peer review system, believing that if it had been employed properly, this study would never have been published and its subsequent harms would have been prevented. Really? I certainly believe in and use the peer review process in my journal but I don’t have an expectation that it’s perfect. If it was, why would we need a blog like Retraction Watch?

Editors’ Pet Peeves and Gold Stars

Every journal editor has particular practices that are favored over others, and some of these are unique to the particular journal.  But there are a handful of almost universal pet peeves, and practices that would earn a gold star, things that make an editor smile!  One issue surfaced recently that prompted me to reflect on some of my particular likes and dislikes, and why.  So I decided to share my personal lists with a brief commentary on each item, and invite other editors to comment and add ideas of your own.

Gold Stars

  • The journal requirements for style and format are followed precisely!  This saves our copy editors hours of excruciating work, and it is a signal that the author has attended to details that make this journal what it is.  A consistent style and format helps readers to focus on the content, instead of being distracted by matters of style.
  • The author’s own voice and message stands out!  I want to know what this author has to contribute to the topic they are addressing so that what we publish is unique, and presents a fresh perspective to our readers.
  • The author uses an active voice, including the use of first person pronouns to refer to themselves.  There is still a lingering belief that professional writing should not use first person pronouns.  To the contrary, the best writing guidelines endorse the use of first person pronouns and an active voice instead of the awkward third-person, passive voice practices of part decades.  I caution authors to use the first person sparingly to avoid excessive “egotism” in their work, but the admonition to not use first person at all is outdated.

Pet Peeves

  • First on this list has to be a failure to earn my “gold star” points!  In fact, failure to adhere to the journal’s style and format is one of the major reasons that I send a manuscript back to the author.  The other two points are not grounds for getting the manuscript rejected, but they do influence the review of the manuscript in less-than-positive way.
  • Failure to respond to editorial communications in a timely manner.  Of course this is a two-way street and I place a high priority on my own prompt and timely communication with authors; I expect the same from authors and reviewers as well.  Timely responses are particularly important once a manuscript goes into production, when we need to have page proofs reviewed and author queries attended to in a time frame that meets the production schedule.
  • Use of the designation “PhD(c).”  I blogged about this issue on the ANS post titled How to list your credentials and title when you publish.  A reader challenged my position and stated that this designation can be used, so I looked into the matter further.  I found  that some Universities do sanction the use of this designation by those who have reached candidacy, but none that I found award this as a degree. A few do award a Candidate in Philosophy (C.Phil) designation, also referred to as an “intermediate degree” but this designation is only good for 7 years, which is the typical time period after which any “candidacy” expires. There is no indication that I can find that affirms the use of this designation as a title. If it is the practice of an institution to use the designation internally, then certainly a doctoral candidate is well advised to use it in that context. However, given that candidacy does expire, I maintain the use this designation in a published work, which will survive the time frame of the designation, is not appropriate.

What are your “gold stars” and “pet peeves?”  Share your comments here!

More on Retraction…from the New York Times

Given the previous post and discussion, I thought this would be of interest to the group.

A Sharp Rise in Retractions Prompts Calls for Reform

By CARL ZIMMER

Dr. Ferric C. Fang

In the fall of 2010, Dr. Ferric C. Fang made an unsettling discovery. Dr. Fang, who is editor in chief of the journal Infection and Immunity, found that one of his authors had doctored several papers.

It was a new experience for him. “Prior to that time,” he said in an interview, “Infection and Immunity had only retracted nine articles over a 40-year period.”

The journal wound up retracting six of the papers from the author, Naoki Mori of the University of the Ryukyus in Japan. And it soon became clear that Infection and Immunity was hardly the only victim of Dr. Mori’s misconduct. Since then, other scientific journals have retracted two dozen of his papers, according to the watchdog blog Retraction Watch.

“Nobody had noticed the whole thing was rotten,” said Dr. Fang, who is a professor at the University of Washington School of Medicine.

Dr. Fang became curious how far the rot extended. To find out, he teamed up with a fellow editor at the journal, Dr. Arturo Casadevall of the Albert Einstein College of Medicine in New York. And before long they reached a troubling conclusion: not only that retractions were rising at an alarming rate, but that retractions were just a manifestation of a much more profound problem — “a symptom of a dysfunctional scientific climate,” as Dr. Fang put it.

Dr. Casadevall, now editor in chief of the journal mBio, said he feared that science had turned into a winner-take-all game with perverse incentives that lead scientists to cut corners and, in some cases, commit acts of misconduct.

“This is a tremendous threat,” he said.

Last month, in a pair of editorials in Infection and Immunity, the two editors issued a plea for fundamental reforms. They also presented their concerns at the March 27 meeting of the National Academies of Sciences committee on science, technology and the law.

Members of the committee agreed with their assessment. “I think this is really coming to a head,” said Dr. Roberta B. Ness, dean of the University of Texas School of Public Health. And Dr. David Korn of Harvard Medical School agreed that “there are problems all through the system.”

o one claims that science was ever free of misconduct or bad research. Indeed, the scientific method itself is intended to overcome mistakes and misdeeds. When scientists make a new discovery, others review the research skeptically before it is published. And once it is, the scientific community can try to replicate the results to see if they hold up.

But critics like Dr. Fang and Dr. Casadevall argue that science has changed in some worrying ways in recent decades — especially biomedical research, which consumes a larger and larger share of government science spending.

In October 2011, for example, the journal Nature reported that published retractions had increased tenfold over the past decade, while the number of published papers had increased by just 44 percent. In 2010 The Journal of Medical Ethics published a study finding the new raft of recent retractions was a mix of misconduct and honest scientific mistakes.

Several factors are at play here, scientists say. One may be that because journals are now online, bad papers are simply reaching a wider audience, making it more likely that errors will be spotted. “You can sit at your laptop and pull a lot of different papers together,” Dr. Fang said.

But other forces are more pernicious. To survive professionally, scientists feel the need to publish as many papers as possible, and to get them into high-profile journals. And sometimes they cut corners or even commit misconduct to get there.

To measure this claim, Dr. Fang and Dr. Casadevall looked at the rate of retractions in 17 journals from 2001 to 2010 and compared it with the journals’ “impact factor,” a score based on how often their papers are cited by scientists. The higher a journal’s impact factor, the two editors found, the higher its retraction rate.

The highest “retraction index” in the study went to one of the world’s leading medical journals, The New England Journal of Medicine. In a statement for this article, it questioned the study’s methodology, noting that it considered only papers with abstracts, which are included in a small fraction of studies published in each issue. “Because our denominator was low, the index was high,” the statement said.

Monica M. Bradford, executive editor of the journal Science, suggested that the extra attention high-impact journals get might be part of the reason for their higher rate of retraction. “Papers making the most dramatic advances will be subject to the most scrutiny,” she said.

Dr. Fang says that may well be true, but adds that it cuts both ways — that the scramble to publish in high-impact journals may be leading to more and more errors. Each year, every laboratory produces a new crop of Ph.D.’s, who must compete for a small number of jobs, and the competition is getting fiercer. In 1973, more than half of biologists had a tenure-track job within six years of getting a Ph.D. By 2006 the figure was down to 15 percent.

Yet labs continue to have an incentive to take on lots of graduate students to produce more research. “I refer to it as a pyramid scheme,” said Paula Stephan, a Georgia State University economist and author of “How Economics Shapes Science,” published in January by Harvard University Press.

In such an environment, a high-profile paper can mean the difference between a career in science or leaving the field. “It’s becoming the price of admission,” Dr. Fang said.

The scramble isn’t over once young scientists get a job. “Everyone feels nervous even when they’re successful,” he continued. “They ask, ‘Will this be the beginning of the decline?’ ”

University laboratories count on a steady stream of grants from the government and other sources. The National Institutes of Health accepts a much lower percentage of grant applications today than in earlier decades. At the same time, many universities expect scientists to draw an increasing part of their salaries from grants, and these pressures have influenced how scientists are promoted.

“What people do is they count papers, and they look at the prestige of the journal in which the research is published, and they see how many grant dollars scientists have, and if they don’t have funding, they don’t get promoted,” Dr. Fang said. “It’s not about the quality of the research.”

Dr. Ness likens scientists today to small-business owners, rather than people trying to satisfy their curiosity about how the world works. “You’re marketing and selling to other scientists,” she said. “To the degree you can market and sell your products better, you’re creating the revenue stream to fund your enterprise.”

Universities want to attract successful scientists, and so they have erected a glut of science buildings, Dr. Stephan said. Some universities have gone into debt, betting that the flow of grant money will eventually pay off the loans. “It’s really going to bite them,” she said.

With all this pressure on scientists, they may lack the extra time to check their own research — to figure out why some of their data doesn’t fit their hypothesis, for example. Instead, they have to be concerned about publishing papers before someone else publishes the same results.

“You can’t afford to fail, to have your hypothesis disproven,” Dr. Fang said. “It’s a small minority of scientists who engage in frank misconduct. It’s a much more insidious thing that you feel compelled to put the best face on everything.”

Adding to the pressure, thousands of new Ph.D. scientists are coming out of countries like China and India. Writing in the April 5 issue of Nature, Dr. Stephan points out that a number of countries — including China, South Korea and Turkey — now offer cash rewards to scientists who get papers into high-profile journals. She has found these incentives set off a flood of extra papers submitted to those journals, with few actually being published in them. “It clearly burdens the system,” she said.

To change the system, Dr. Fang and Dr. Casadevall say, start by giving graduate students a better understanding of science’s ground rules — what Dr. Casadevall calls “the science of how you know what you know.”

They would also move away from the winner-take-all system, in which grants are concentrated among a small fraction of scientists. One way to do that may be to put a cap on the grants any one lab can receive.

Such a shift would require scientists to surrender some of their most cherished practices — the priority rule, for example, which gives all the credit for a scientific discovery to whoever publishes results first. (Three centuries ago, Isaac Newton and Gottfried Leibniz were bickering about who invented calculus.) Dr. Casadevall thinks it leads to rival research teams’ obsessing over secrecy, and rushing out their papers to beat their competitors. “And that can’t be good,” he said.

To ease such cutthroat competition, the two editors would also change the rules for scientific prizes and would have universities take collaboration into account when they decide on promotions.

Ms. Bradford, of Science magazine, agreed. “I would agree that a scientist’s career advancement should not depend solely on the publications listed on his or her C.V.,” she said, “and that there is much room for improvement in how scientific talent in all its diversity can be nurtured.”

Even scientists who are sympathetic to the idea of fundamental change are skeptical that it will happen any time soon. “I don’t think they have much chance of changing what they’re talking about,” said Dr. Korn, of Harvard.

But Dr. Fang worries that the situation could be become much more dire if nothing happens soon. “When our generation goes away, where is the new generation going to be?” he asked. “All the scientists I know are so anxious about their funding that they don’t make inspiring role models. I heard it from my own kids, who went into art and music respectively. They said, ‘You know, we see you, and you don’t look very happy.’ ”

Source: The New York Times

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.

Centers of Excellence in Nursing Education

National League for Nursing Announces New Centers of Excellence™

Selected Schools to Be Recognized During 2011 NLN Education Summit

New York, NY — July 27, 2011 — Eight schools of nursing, representing programs across the academic spectrum, have been chosen NLN Centers of Excellence, the League has announced. These schools will be formally recognized at a special presentation on Friday, September 23 at 9:00 am at the NLN’s annual Education Summit in Orlando, FL. The four-day gathering every year draws a capacity crowd of nurse faculty, deans, administrators, and professionals from allied health organizations. The COE presentation will directly follow the NLN CEO Summit Address at 8:30 am.”Schools work hard to earn the coveted COE designation,” said NLN CEO Beverly Malone, PhD, RN, FAAN. “What we seek are measurable results and best practices, and the NLN is pleased to publicly name those schools that have demonstrated their understanding of excellence in the concrete terms that the COE application demands.” Schools may earn COE status in one of three categories: Enhancing Student Learning and Professional Development; Promoting the Pedagogical Expertise of Faculty; or Enhancing the Science of Nursing Education.

Six of this year’s eight schools are repeat COE designees, with two—Excelsior College in Albany, NY and University of North Carolina at Greensboro—earning their third consecutive COE designation. This has entitled them to now carry the COE designation for an additional year, from 2011 to 2016. (COE schools are now designated for a four-year period; until 2011, the initial designation was for three years.) Excelsior has been chosen in the category of Enhancing Student Learning and Professional Development, UNC-Greensboro in Promoting the Pedagogical Expertise of Faculty.

The other four repeat Centers of Excellence are currently completing their initial term, all for Enhancing Student Learning and Professional Development. Duquesne University (Pittsburgh, PA); East Carolina University (Greenville, NC); Regis College (Weston, MA); and Trinitas School of Nursing (Elizabeth, NJ) will carry the designation from 2011-2015.

First-time designees Collin College (McKinney, TX), for Enhancing Student Learning and Professional Development, and University of Connecticut (Storrs, CT), for Promoting the Pedagogical Expertise of Faculty, have been named Centers of Excellence for the 2011-2015 term.

Each year since 2004, the NLN has invited nursing schools to apply for COE status, based on their ability to demonstrate sustained excellence in faculty development, nursing education research, or student learning and professional development. Schools must also have a proven commitment to continuous quality improvement.

Throughout the four or more years that schools carry the COE designation, they are expected to serve as advisers and sounding boards to other nursing programs that seek to gain COE distinction. “The COE banner carries with it a responsibility to the entire academic community,” noted Cathleen Shultz, PhD, RN, CNE, FAAN, president of the NLN. “We expect that COE schools will help educate and inspire others, thus elevating the standards of excellence throughout all levels of higher education in nursing.”

Also, each year, students enrolled in COE schools have an opportunity to share their thoughts on the meaning of excellence in nursing education, what fosters excellence, and what it means to them to be part of a COE-designated nursing program. As in years past, the winner of the Student Excellence Paper Competition will be announced at the COE presentation. She is Tuesday Majors from Indiana University School of Nursing. Her winning submission is entitled “Excellence in Nursing Education.”

Free Titles from the National Academies Press

MORE THAN 4,000 NATIONAL ACADEMIES PRESS PDFs

NOW AVAILABLE TO DOWNLOAD FOR FREE

The National Academies—National Academy of Sciences, National Academy of Engineering, Institute of Medicine, and National Research Council—are committed to distributing their reports to as wide an audience as possible. Since 1994 we have offered “Read for Free” options for almost all our titles. In addition, we have been offering free downloads of most of our titles to everyone and of all titles to readers in the developing world. We are now going one step further. Effective June 2nd, PDFs of reports that are currently for sale on the National Academies Press (NAP) Website and PDFs associated with future reports* will be offered free of charge to all Web visitors.

For more than 140 years, the NAS, NAE, IOM, and NRC have been advising the nation on issues of science, technology, and medicine. Like no other collection of organizations, the Academies enlist the nation’s foremost scientists, engineers, health professionals, and other experts to address the scientific and technical aspects of society’s most pressing problems. The results of their work are authoritative and independent studies published by the National Academies Press.

NAP produces more than 200 books a year on a wide range of topics in science, engineering, and health, capturing the best-informed views on important issues. Of particular interest to readers of this blog is The Future of Nursing: Leading Change, Advancing Health which was released earlier this year.

We invite you to visit the NAP homepage and experience the new opportunities available to access our publications. There you can sign up for MyNAP, a new way for us to deliver all of our content for free to loyal subscribers like you and to reward you with exclusive offers and discounts on our printed books. This enhancement to our free downloads means that we can reach out even further to inform government decision making and public policy, increase public education and understanding, and promote the acquisition and dissemination of knowledge.

*There are a small number of reports that never had PDF files and, therefore, those reports are not available for download. In addition, part of the series, “Nutrient Requirements of Domestic Animals” are not be available in PDF and future titles in this series will also not have PDFs associated with them.