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.