More on Review Claiming Abortion Hurts Women's Mental Health
Author had conflict of interest, used scare tactics.
Posted Nov 15, 2011
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.".
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.
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.