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This is the third in a series of blogs discussing a controversial review in British Journal of Psychiatry (BJP) by American Priscilla Coleman claiming that abortion poses considerable risk to the mental health of women and that its effects account for over a third of suicides among American women of reproductive age. The first blog discussed the claims of review as they were spread across the United States by anti-choice websites. The second blog exposed the pseudo-science in the conclusions of the review. I also showed how the conclusions were sharply contradicted by other authoritative sources, including a draft report from the Royal College of Psychiatrists which publishes BJP.
Since I posted my blog, E-letters continue to appear at the journal website, most of them offering scathing critiques of the review and sometimes questioning the decision of the journal to publish it. You can continue to follow these updates by clicking on the E-letter link. The E-letter from Ben Goldacre is particularly noteworthy. A British psychiatrist, he was recently appointed by BJP editor as Co-Editor for Debate, and is best known as the author of a Guardian column and book, both with the same title, Bad Science.
Goldacre, true to form, laid bare the pseudoscience of the review. He tracked down a PowerPoint presentation of Priscilla Coleman, author of the review and raised the issue of a serious conflict of interest that she did not disclose. Goldacre noted that the PowerPoint presentation explicitly declared:
We need to develop organized research communities to continue the research, apply for grants, recruit young academics, critique data produced by pro-choice researchers, challenge politically biased professional organizations, train experts to testify, and disseminate cohesive summaries of evidence.
Yet, take a closer look at Coleman's PowerPoint presentation that even more boldly reveals her perspective:
The rapidly accumulating literature on the negative effects of abortion is rarely made available to practitioners and to women considering abortion as professional organizations, including the APA and the AMA, along with the liberal press expend incredible amounts of energy to hide the now scientifically verified truths.
Hmm, do the American Psychological Association and the American Medical Association "expend incredible amounts of energy to hide the now scientifically verified truths"? Well, an APA task force report did find that Coleman studies—the ones she included in her meta analysis—had inadequate or inappropriate controls and did not adequately control for women's mental health prior to the pregnancy and abortion. A similar verdict about Coleman's work was contained in the draft Royal College of Psychiatrists report that also considered the bulk of her work too weak and biased to be entered into an evaluation of the effects of abortion on mental health. A response to Coleman's BJP article from the Royal College of Obstetricians and Gynaecologists (RCOG) voiced similar concerns. So, are the APA, AMA, Royal College of Psychiatrists, and RCOG united in some kind of a conspiracy to suppress the truth? And who else should we add to the conspiracy? Perhaps the many critics of a study by Coleman and her co-authors, who stated in in a letter to the Journal of Affective Disorders: "We believe that Cougle, et al., operate with strong political views regarding abortion, and unfortunately their biases appear to have resulted in serious methodological flaws in the analysis published in your journal. [Reardon, Coleman and Cougle] are involved in building a literature to be used in efforts to restrict access to abortion.".
Dr. Priscilla Coleman
Did Priscilla Coleman write her review with the intention of building a literature to restrict access to abortion? David Reardon is Coleman's co-author on ten of the articles included in her meta-analysis and according to the NY Times is know as the "Moses of the anti-abortion movement." In an article, he announced his intention rather explicitly:
For the purpose of passing restrictive laws to protect women from unwanted and/or dangerous abortions, it does not matter if people have a pro-life view. The ambivalent majority of people who are willing to tolerate abortion in "some cases" are very likely to support informed consent legislation and abortion clinic regulations, for example, because these proposals are consistent with their desire to protect women. In some cases, it is not even necessary to convince people of abortion's dangers. It is sufficient to simply raise enough doubts about abortion that they will refuse to actively oppose the proposed anti-abortion initiative. In other words, if we can convince many of those who do not see abortion to be a "serious moral evil" that they should support anti-abortion policies that protect women and reduce abortion rates, that is a sufficiently good end to justify NRS efforts. Converting these people to a pro-life view, where they respect life rather than simply fear abortion, is a second step. The latter is another good goal, but it is not necessary to the accomplishment of other good goals, such as the passage of laws that protect women from dangerous abortions and thereby dramatically reduce abortion rates.
In his E-letter, Goldacre notes the BJP subscribes to the International Committee of Medical Journal Editors uniform requirements for declaration of conflict of interest, mandating declaration of "any relevant non-financial associations or interests (personal, professional, political, institutional, religious, or other) that a reasonable reader would want to know about in relation to the submitted work." An article in BJP goes further in underscoring the need to declare nonfinancial conflicts of interest, among the most important being an agenda-driven bias, by which authors seek to influence legislation and social policy.
Associate Editor Casey
In submitting her article, Coleman had to sign a declaration of conflict of interest form and her article states that she declared none. Should the editor and peer reviewers of her article have known of her well-established conflict of interest? How did such flawed and biased article ever get into BJP? One disturbing possibility is by way of the influence of an Associate Editor of the BJP, Irish psychiatrist Patricia Casey. She, unbelievably, has an even stronger track record than Coleman of letting ideology intrude into evaluations supposedly based on evidence. Not only does she have ties to the American anti-abortion movement, she is on record as claiming this scientific evidence backs that having parents divorce is more traumatic for young children than having one of the parents die.
BJP Editor Tyrer
BJP's editor, Peter Tyrer should clarify whether Patricia Casey was involved in the decision to accept Coleman's paper, with its serious flaws, deliberate misrepresentations, and undeclared conflicts of interests. The paper should never have been accepted and its publication warrants retraction. If you agree, you can write to the editor at p.tyrer@imperial.ac.uk
In my next blog, I will provide a set of tools for independently evaluating whether a systematic review or meta-analysis is at high risk of being biased. The publication of the Coleman review shows that we cannot depend on peer review and editorial oversight to ensure that reviews and meta-analyses represent best evidence. Readers need to be prepared to evaluate and judge for themselves and not just make assumptions about the quality and accuracy of a paper simply on the basis of it having been published.
