Don’t believe everything you read in peer-reviewed journals

In a recent post I wrote about electroconvulsive therapy (ECT) in the Ozarks. I had never heard of the Ozarks but I looked them up and discovered that they are a region in the middle of the United States.

It is easy enough to look things up, so there is no excuse for the peer-reviewed journal Psychosomatics to publish a claim by American psychiatrist Max Fink that the town of Camelford is in southeastern England when in fact it is in Cornwall, in the southwest of England.

Peer review is the system by which articles submitted to scientific journals are reviewed by experts in the field (the peers). It is supposed to be a form of quality control. This is how the charitable trust Sense about Science (“equipping people to make sense about science and evidence”) explains it:

“There is a system called peer review that is used by scientists to decide which research results should be published in a scientific journal. The peer review process subjects scientific research papers to independent scrutiny by other qualified scientific experts (peers) before they are made public”.

Max Fink has devoted much of his career to using, writing about, and promoting ECT. He has been publishing articles on the subject since the 1950s. The article in question was published by Psychosomatics in 2007 with the title “Complaints of loss of personal memories after electroconvulsive therapy: evidence of a somatoform disorder?” In the article Fink argues that people who experience loss of memories after ECT are actually suffering from “a somatoform disorder” and not from the effects of ECT. Where does Camelford, a town in Cornwall where the water supply was contaminated in 1988, come into it? Fink writes: “The British Camelford incident and its social consequences offer a model”. But he locates the town in “southeastern England” when it is in fact it is right the other side of the country in southwest England. At the end of the article he acknowledges four psychiatrists and a medical historian for their “helpful critiques”. Didn’t one of those – not even one of the two who live in the United Kingdom – spot the error? And did none of the peer reviewers, supposedly experts in the area, know enough about Camelford to know where it actually is? As for the bit about ECT, Fink discusses two people who experienced memory loss after ECT. One of them was Marilyn Rice, who was featured in an article in the New Yorker magazine in 1974. Evidently none of the peer reviewers or the helpful critiquers had read the New Yorker article and didn’t spot Max Fink’s errors. For example, he starts by saying that Marilyn Rice became depressed when she had all her teeth extracted and replaced by dentures, when in fact, as the New Yorker article makes clear, she had orthodontic work which left her wearing braces rather than having all her teeth extracted. He gets the length of her hospital stay and treatments before ECT wrong, and misquotes her talking about a rest cure. But more importantly – since he argues that “histories of prolonged depressive illness marked by somatic features and suicidal episodes” are features of “complainants” – Fink claims that before ECT Marilyn Rice “had been hospitalized for multiple suicide attempts” which is untrue. She had never previously been hospitalized and had never attempted suicide.

One of the criticisms that has been made about peer review is that it suffers from bias, with articles that reinforce the prevailing beliefs of a discipline being more likely to be accepted than ones which challenge them. Psychosomatics is published by American Psychiatric Publishing, the publishing arm of the American Psychiatric Association (APA), and the APA’s official line is that ECT is a safe treatment that does not cause significant memory loss. So perhaps any article arguing that memory loss after ECT isn’t due the treatment but to something else would be looked on favourably, however error-strewn it might be.

Sense about Science’s booklet on peer review says: “Peer review means that other scientific experts in the field check research papers for validity, significance and originality – and for clarity”. Is it significant that it doesn’t include accuracy in that list? Perhaps, as far as the APA’s journals are concerned, anything which supports the use of ECT is valid even if it isn’t accurate, or perhaps even anything written by Max Fink passes the validity test since he is one of the foremost supporters of ECT.

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