British Journal of Psychiatry: ^NOT 'Prestigious'

While writing yesterday's blogpost on Vellacott's references section, I found that the current issue of the British Journal of Psychiatry revisits the Coleman (with four citations from Vellacott) controversy with letters to the editor, the editors' response, and author's reply.

They are not yet available online, but available to subscription holders and to a grand friend of DJ! with access to a university sub -- thanks again, godammitkitty.

Here's the abstract of her paper with previous critical letters to the editor.

The criticism focuses on three major shortcomings in her work which found (astoundingly):

Results: Women who had undergone an abortion experienced an 81% increased risk of mental health problems, and nearly 10% of the incidence of mental health problems was shown to be attributable to abortion.

Methodology

Logic

Bias

I won't address methodology, not being a statistician, but I'll quote one para in which I count 10 negatives:

This quantitative synthesis and meta-analysis did not follow the robust methodologies now generally accepted for systematic reviews.2 There is no detail of the search strategy including search terms; the strategy is not comprehensive (only two databases included); other strategies to search the literature, including citation tracking, hand searching and contacting authors and experts in the field to try to minimise publication bias, were not carried out; and there was no assessment or rating of the quality of included studies, so that only those of at least reasonable quality are included in the meta-analysis. This is particularly important here as many of the primary studies included in this review have significant methodological limitations, including non-prospective design, non-standardised measures of mental disorders, lack of adjustment for pre-existing mental illness, lack of adjustment for other key confounders (e.g. social deprivation), non-comparability of exposed and non-exposed groups, and selection bias. This is especially concerning, given that previous reviews raised serious methodological concerns about some of the included studies, and came to different conclusions when these were excluded from analyses.3–5 Furthermore, results from several of the included studies linking abortion to mental health problems have since been re-analysed by other researchers. These studies, using the same data, have less biased sample selection techniques and control for pre-pregnancy factors known to influence poor mental health outcomes (i.e. rape history) and have found no significant links between abortion and subsequent poor mental health.6,7

-- Louise M. Howard, Kylee Trevillion, and Trine Munk-Olsen

Kathryn M. Abel and Peter Brocklehurst single out her use of something called population atributable risk (PAR).

In Coleman’s synthesis, the PAR measure has been applied inappropriately and, we believe, reported misleadingly.

There is much much more of this sort of criticism, featuring the words 'not', 'failed', and so on. It's pretty apparent she fucked up majorly in the methodology.

Now, on logic, I'm on stronger ground. As I argued at the time, correlation does NOT equal causation. Something, Abel and Brocklehurst also note:

Second, in the first paragraph of the Discussion (p.183), Coleman states with apparent certainty that ‘. . . nearly 10% of the incidence of mental health problems was shown to be directly attributable to abortion.’ This is about as unambiguous a statement of causality as could possibly be made, in the face of clear guidance on the potential pitfalls of drawing such conclusions when applying the PAR.

Well, duh. The correlation/causality fallacy is dealt with early in basic logic, classic example being: 'If the streets are wet, it's raining'.

I'm ready to sit corrected, but it seems to me that her flouting this basic basic basic law of logic is what got up most scientists' (and non-scientists') noses.

Next, her declaration of 'conflict of interest' was, incredibly: 'None.'

Julia H. Littell and James C. Coyne say:

An article in the British Journal of Psychiatry6 calls attention to the importance of non-financial conflicts of interest in the psychiatric literature. Coleman has at least two types of conflict of interest here. Among the most important of such conflicts is an agenda-driven bias, by which authors seek to influence legislation and social policy. David Reardon is a co-author with Coleman on seven articles included in the review and an author on an additional study in the review that does not involve Coleman as a co-author. Reardon is quite explicit about his agenda to instil fear of abortion as a way of facilitating passage of anti-abortion legislation.7

Coleman is the first author on 6 studies and co-author on 5 additional studies in her review; thus, she authored or co-authored fully half of the 22 studies included. According to the Cochrane Handbook,8 this is another potential conflict of interest, since it may ‘unduly influence judgements made in a review (concerning, for example, the inclusion or exclusion of studies, assessments of the risk of bias in included studies or the interpretation of results) . . . This should be disclosed in the review and, where possible, there should be an independent assessment of eligibility and risk of bias by a second author with no conflict of interest.’ Coleman did not obtain an independent assessment of the studies she authored or co-authored, nor did she acknowledge these conflicts in the review.

That's enough for now, except to note that David Reardon and Fergusson et al., (the latter also among the references provided by Vellacott) both defend her. And they are the only ones to do so. Surprise.

Here are Littel and Coyne again:

It is unclear how this paper got through peer review at the Journal. It appears that peer reviewers and the Editor ignored published standards for systematic reviews and meta-analyses. Given the serious methodological flaws contained in Coleman’s review and the author’s failure to report obvious conflicts of interest, we believe the article should be retracted.

Let's hear from the editor of the 'prestigious journal' itself, shall we (emphasis and parenthetical comments mine)?

The article by Coleman1 was submitted in October 2010 and accepted for publication in March 2011, so predated the Munk-Olsen paper [yet another paper finding NO causality] paper ,2 as Coleman has indicated in her reply below. The handling editor was W.W. [Waquas Waheed] and the paper was accepted after revision with two reviewers supporting publication and one recommending rejection. It was recognised that the paper was likely to attract attention and P.T. [Peter Tyrer] suggested that a commentary should be published alongside the article. Unfortunately the major concurrent work [guess what it concluded] on this subject (commissioned by the Department of Health) had not then been completed and it was felt unfair to delay publication, so the article appeared without comment. Dr Coleman stated that she had no conflicts of interest to declare and when invited to revise this view subsequently when reminded of our guidance again reiterated this. She has again defended this in her letter; readers are free in the light of these full statements to come to their own conclusions. The failure to declare an interest is not a reason for retracting a systematic review even if failure was unequivocally demonstrated, and this situation is very different from other ones in which the publication of a paper has been retracted.3 [This footnote goes to the infamous Lancet retraction of the autism/vaccine fraud] We have nevertheless decided to give new guidance for the preparation of reviews in our authors’ instructions so there is greater clarity for both authors and reviewers. The correspondence and commentary in this issue indicates the importance of the subject and the value of an active correspondence column in a journal; it is not a reason to avoid the publication of a controversial subject.

Shorter: We didn't want to wait; it was going to generate (fun!) controversy; so what she lied; but we're changing the rules anyway.

Weasels.

But the real fun comes in Priscilla's defense of herself. She's NOT biased. Everyone else is.

By raising concerns of publication bias and attempting to undermine the credibility of an individual researcher who managed to publish in a high-profile journal, several people have sought to shift attention from the truly shameful and systemic bias that permeates the psychology of abortion. Professional organisations in the USA and elsewhere have arrogantly sought to distort the scientific literature and paternalistically deny women the information they deserve to make fully informed healthcare choices and receive necessary mental health counselling when and if an abortion decision proves detrimental.

To recap: bad science, conflict of interest, sloppy review, poor editorial oversight, only defenders also fetus fetishists = ALL GOOD.

I can't wait to hear what James Coyne and PZ Myers will have to say.

For my part, the word 'prestigious' will never appear in front of the words 'British Journal of Psychiatry' again. I'm thinking maybe 'shitty' or 'sensation-seeking' or 'weaselly'.

Aside: Priscilla Coleman is something of a hobby here at DJ! That link demonstrates the strength of our interest.