Tag: ethics

GHOST WRITER

Ghost rider

This article will apply mostly to medical researchers. It is boring to read, but this is the type of stuff that I had to write while in the Doctorate program. I can sound smart at times. Enjoy or use it for toilet paper.

 

Alexander LL. Ghostbusting. AMWA Journal. 2008;23(2):54-55

  1. “’Biomedical communicators who contribute substantially to the writing or editing of a manuscript should be acknowledged with their permission and with disclosure of any pertinent professional or financial relationships’”

This quote still doesn’t denote that ghostwriting is a horrible topic. For instance, a person can ghostwrite by not giving permission to be acknowledged, based on the above quote.

  1. “There are two types of ghostwriting. Writing a paper for which you receive no author credit (but for which you get paid) and authoring a paper to which you contribute no work. The first type of ghostwriting is not illegal and is hardly unethical…the second type of ghostwriting is more troublesome’” This touches on the topic of payment. One of the other articles that we were to read also discusses payment and stated to the effect that being paid for services does not take the place of authorship.

 

Yoshikawa TT, Ouslander JG. Integrity in Publishing: Update on Policies and Statements on Authorship, Duplicate Publications, and Conflicts of Interest. JAGS. 2007; 55(2):155-157.

 

  1. “The principles of this document, including those related to overlapping (duplicate) publications, authorship, and disclosure of potential COI, apply equally to manuscripts for consideration in this Journal or in a separate supplement.”

I appreciate the straightforwardness of the above statement. There is no ambiguity in the statement and it simply states that these rules apply only to this journal.

  1. “authorship credit should be based on substantial contributions to conception and design, acquisition of data, or analysis and interpretation of data, drafting the article or revising it critically for important intellectual content; and final approval of the version to be published. Authors should meet all three conditions.”

The statement of “substantial contributions” has not been defined. This is left to interpretation in multiple studies. The use of the word “or” is powerful in that the author can partake in one of the three listed activities in the first sentence, but doesn’t have to partake in all activities. The author would have to be active in the drafting of the article and the final approval of the article for publication.

  1. “Within the Acknowledgments section and under the subheading ‘Authors’ Contributions,’ all authors’ specific areas of contributions should be listed”

I have read a lot of research articles over the years and do not recall reading this in any of the sections.

 

Wen Q, Gao, Y. Viewpoint: Dual Publication and Academic Inequality. Int J Applied Linguistics. 2007;17(2):221-225.

  1. “Some of our colleagues believe that submission of the same research findings in different languages is a violation of academic ethics: such a practice constitutes self-plagiarism”.

The authors are starting to make their case that they do not believe that submission in a separate language is plagiarism.

  1. ”We are among those who believe otherwise. In our view, this practice has little to do with self-plagiarism and does not violate intellectual ethics.”

I would disagree with this statement, as the authors are not performing anything new in the study, but simply translating a study from its original language. This should be listed in the article that the study is a translation and not an original work.

  1. “for the above reasons, we strongly propose a relaxation in the rule that international journals only publish “original” papers that have not been published anywhere before, taking into consideration the disadvantaged position of …”

I personally have an issue with this statement, as it is asking for a “relaxation of rules”. We discussed this semester how some ethical issues come to the forefront. It is persons like this, whom are able to rationalize plagiarism that ethics in action always has to remain at the forefront.

 

Geelhoed RJ, Phillips JC, Fischer AF, et al. Authorship Decision Making: An Empirical Investigation. Ethics & Behavior. 207;17(2): 95-115.

  1. “Both the 1992 and 2002 versions of the code state that ‘authors take responsibility and credit, including authorship credit, only for work they have actually performed or to which they have contributed’, with the 2002 version also qualifying the last word with the adjective substantially.

Again the word substantially is included, but is left open to interpretation.

  1. “Significant differences between groups regarding authorship decisions were noted when faculty assigned significantly more credit to students than did student participants and students assigned significantly more credit to the advisor than did faculty.”

I find this statement interesting. The faculty may be trying to assist the students with authorship publication, but this may set a poor

precedent, which continues to proliferate. For example, many of us have stated that faculty should serve as mentors, but would we agree that it isn’t appropriate to give first authorship to someone that did not perform all of the prerequisite work required to have the first authorship position.

  1. “38% of author positions were misplaced relative to their contribution…seven authors in the sample were given authorship credit when they had made no contributions to the study.”

This is a good example of how authorship may be misunderstood or confusing for some.

  1. “discussing authorship in the planning stage of a project while allowing for changes”

This is an excellent point that the discussion regarding authorship should start at the initiation of the planning phase for the study in order to reduce confusion or dissension

  1. “untenured faculty were more likely to report ath both power diffentials and a sense of loyalty or obligation influenced the decision-making process…untenured faculty more frequently reported that unwarranted authorship had been granted than did tenured faculty”

This demonstrates that a person’s place in the “pecking order” may dictate authorship.

 

Louis KS, Holdsworth JM, Anderson MS, Campbell EG. Everyday Ethics in Research: Translating Authorship Guidelines into Practice in the Bench Sciences. J Higher Education. 2008;79(1):88-112.

  1. “Issues related to authorship extend beyond disciplinary boundaries and relate to intellectual ownership and the competitive nature of the academic enterprise…academic researchers are awarded funding, prestige, prizes, promotions and tenure based almost exclusively on their publication history”

This may be the first issue with research. There is a “prize” at the end of the tunnel. We discussed in previous weeks regarding conflicts of interest. The fact that the “teachers” stand to profit from the research should be stated in the publication of the research.

  1. “most scientists are reluctant to exclude people from authorhip”

This is interesting. In our class, we discuss how the authorship should earned based on the requirements of publication, but scientists see no harm with assisting with the advancement of others, although they may have not performed the requisite work for authorship.

  1. high-impact compared to major journals

This is the first that I have seen a comparison such as this. I like how they defined each.

  1. Fairness “Authorship credit should be based only on (1) substantial contributions to conception and design, or acquisition of data, or analysis and interpretation…”

This is how we all seem to interpret the research based on the answers submitted for publication. Based on this alone, there should only be one author of the publication.

  1. “My rule of thumb that is somebody who would read the paper and be able to defend it, or defend their part of it”

This is an interesting part, in that some scientists don’t believe that all three must be met. An author only has to be able to defend the part in which he/she participated. This goes against the initial rule that an author must have had a say in the publication of the article, as this is not stated in the scientists opinion.

  1. “(Adding authors) has no negative effect on my reputation as a scientist if there are four names rather than three names (on a paper), but it can make a huge difference to a student or even a technician”

I agree with this statement. If someone performed work on the paper and the work was deemed substantial to the group, then the person should be added. This needs to be discussed prior to starting the study though.

  1. “Scientists have little, if any, motive to deny authorship”

This comment is comical. In PT, it is not uncommon to read 7-8 names in a study. This may be due to that fact that little is lost from including additional authors.

  1. Based on this article, all of the authors listed in the assignment may be entitled to authorship credit.

 

Washburn JJ. Encouraging Research Collaboration Through Ethical and Fair Authorship: A Model Policy. Ethics and Behavior. 2008;18(1):44-58.

  1. “It may be possible to avoid problems with authorship credit by explicitly discussing authorship credit and order, preferably at the outset of research collaborations.”

This point continues to be emphasized in articles. It appears that basic communication may be lacking in research.

  1. “they propose that for the same level of authorship credit, a greater contribution should be expected fro contributors with greater competence and less of a contribution should be expected from contributors with less competence”

This brings the issue of fair vs. equal. I don’t understand how this type of statement can be made. How can one grade fairness in terms of the sliding scale of competency?

  1. “…the policy proposes that contributions be weighted such that contributors with greater competence must make greater contributions for the same authorship position than those with less competence”

I completely disagree with this type of authorship. Someone with little input could be placed as the lead author because, although they provided little in terms of the actual publication, they have little experience, which would balance out the production performed. It doesn’t seem appropriate.

Medicine’s dirty little secrets

This is another paper from my previous doctorate program.  This is long and can be complex at times, just know that medicine and health care is a business.  In this business, the end goal is to take your money, otherwise known as making a profit.  Everyone can see that the shady car salesman is trying to take the money from your pocket and place it into his.  For some reason, we have trouble seeing the shady little scientists doing the same thing.  Picture Pinky and the Brain.  Pinky and the Brain…Pinky and the Brain…One is a genius, the other’s insane.  Welcome to the healthcare.

 

Couglin SS, Barker A, Dawson A. Ethics and Scientific Integrity in Public Health, Epidemiological and Clinical Research. Public Health Reviews. 2012;34:1-13.

 

“It can be intrinsically unethical because it may involve activities held to be wrong in themselves such as deception, misrepresentation and falsification. It can also be extrinsically unethical because such actions can cause direct harm to individuals and populations where such research is relied upon, negatively impact public trust in and support for research and result in wasted research resources.”

I appreciate the first quote as it discusses the basic ethical principles, as we have already discussed these in the course. There has been little discussion thus far as to how these discussions could affect future research trial that attempt to replicate the original research.

 

“narrow…way. On this model we might think of integrity as abiding by the relevant research ethics rules or regulations”

This is a very narrow way of looking at integrity. There may be many practicing, which according to the narrow way, do not practice with integrity. Some of the written rules do not account for the “internalistic account”. For example, some insurances only pay for up to ten sessions of traction, whereas there is a sub classification of traction, which will typically only respond well to traction initially, for LBP. For this group, it go against my internal integrity to not provide the treatment in which the research reports the best results.

 

“…rather than it being quickly concluded that a piece of research is unethical because it does not meet a presumed requirement, such as the need for informed consent.”

This is an excellent statement. It is up to the reader to be able to critically analyze research and come to his/her own conclusions regarding the ethics of the research. If a written informed consent is not applied, but a verbal is implied, is this unethical? We all practice with verbal consent (when we educate and then proceed) and sometimes we practice with an implied consent (when we apply what seems to be a benign treatment such as postural correction).

 

“…integrity need not always be about following the rules, as much as being able to see that different kinds of moral considerations are important, often conflict, and that sometimes difficult decisions have to be made about priorities.”

This article is excellent in that it places the autonomy of decision in the practitioner’s/researcher’s hands.

 

“Honest error or scientific differences in the design and conduct or research or interpretation of study findings do not constitute scientific misconduct”

This is a great statement, although I don’t necessarily agree. As professionals, we should attain for the least amount of error. When a grievance is performed, it would be hard to prove that it was performed intentionally.

 

“When properly executed, study protocols ensure the integrity of the process used to answer a single research question or a series of questions. However, when not adhered to, negative consequences, such as the inability to reproduce a study in order to verify its validity or the loss of confidence in research findings, can ensue”.

I wonder how often studies reproduced, and published, in the field of physical therapy? Rarely is a study reproduced in my readings, but studies typically utilize protocols performed in previous studies. This is discussed at length with clinical prediction rules for the spine. These studies are created utilizing characteristics that are the most common for treating/classifying patients, but follow-up studies to reproduce (confirm) the original study is rarely performed.

 

Sax JK. Protecting Scientific Integrity: The Commercial Speech Doctrine Applied to Industry Publications. American Journal of Law & Medicine. 2011;37:203-224.

 

“…companies will publish positive results of their clinical trials. They tend not, however, to disclose negative results of clinical trials in scientific publication, or they down-play the negative results…No regulation requires that industry publish negative results…”

The article is staring with an obvious bias against pharmaceutical companies. At no point in my career have I heard about other industries such as physical therapy being reprimanded for not publishing negative results. Beyond the fact that negative results are not submitted for publication, it is possible that a negative result would not be published in a peer reviewed journal to begin with, as this has been previously documented and is also covered later in the article. “Previous studies demonstrate that industry publications have a bias in that they tend to report positive results of clinical trials.” This initial paragraph sets the tone of attacking the establishment of “big pharm”.

 

“…(s)tudies funded by pharmaceutical companies were nearly 8 times less likely to reach unfavorable qualitative conclusions than nonprofit-funded studies and 1.4 times more likely to reach favorable qualitative conclusions.”

The author states this as if we, as the readers, should be surprised. As a class, we have already discussed COI, and when those that stand to profit from the results fund the study, we should not be surprised by the favorable results.

 

“Instead of subjecting themselves to peer review, some members of industry will skirt around this system by creating their own publications, such as symposium issues, which allows them to promote their products without having the academic and scientific community review the research prior to publication”

Although I find this to be unethical, I must say that it is an ingenious way to get around the establishment in order to make a profit. Unfortunately, that profit may be the result of harm. Although I wouldn’t make the same decisions, the decisions are understandable in a profit driven society.

 

“The tobacco industry also wrote review articles, citing their own work. Policymakers often rely on review articles because they are supposed to provide a summary of the most up-to-date data. Another tactic utilized included suppressing or criticizing research that did not support the tobacco industry’s position”

Again, these statements demonstrate the articles purpose of demonizing portions of the pharmaceutical companies practices. To compare pharmaceutical companies with the tobacco industry, the author is essentially comparing a company that the reader may not have a strong feeling towards to a company that most in America can rally against.

 

“…the FACT Act did not become law.”

This is shameful. There were good ideas implemented in the FACT Act, that would have allowed the reader to make individual conclusions, instead of taking the authors word regarding the conclusion.

 

“If the expected value of noncompliance is positive, then the rational pharmaceutical company will ignore the regulation and violate the law because the incentives create a regime where it is cheaper for them to ignore the law”

Although this makes sense, applying a larger financial penalty in order to obtain results does not historically work. For instance, the price of cigarettes continues to rise, but there are still smokers. Obviously there is more than finances at stake with this example, but the authors opened the door by introducing tobacco companies in the argument. The tobacco industry is the reason why this rationale does not work.

 

“[u]ntruthful speech, commercial or otherwise, has never been protected for its own sake…a state may regulate commercial speech that is provably false, deceptive, or misleading.”

This forces the burden of proof on the state that the company was knowingly being deceptive and misleading. These cases that are proven are the landmark cases, such as the teenage antidepressant case presented in the study. There are few landmark cases presented in the article. On a side note, the teenage antidepressant study was so influential that an episode of Law and Order was created similar to the case.

 

Rohr JR, McCoy KA. Preserving environmental health and scientific credibility: a practical guide to reducing conflicts of interest. Conservation Letters. 2010;3:143-150.

I had little vested interest in this article, so there are fewer quotes that I found to comment.

 

“Perhaps the most commonly used strategy to avert undesired environmental and public health decisions is to manufacture uncertainty”

This is not necessarily an evil concept in my opinion. If the evidence is lacking, then “manufacturing uncertainty” is easy. If the evidence is overwhelmingly in support of a specific action, such as the earth circles the sun, then manufacturing uncertainty is impossible. I find the burden for this to be on those in support of those attempting to preserve the environment. For instance, in 2007 the Illinois chiropractors were trying to take mobilizations away from physical therapists. We had ample evidence to demonstrate that we not only owned the technique (thanks to Mary McMillan), but also owned the wording. Because of the evidence cited over the previous century, we were able to prevent this loss.

 

“…delay regulations that might be necessary to protect environmental health.”

This is an opinion of the author and seeing as how this paper is meant to be a persuasion based paper, it should be omitted or cited if there is evidence to support this.

 

“Some authors have even argued that conservation science, with its mission of advancing the sience and practice of conserving the Earth’s biological diversity, is normative and biased and thus can be perceived as having a conflict of interest.”

I can appreciate the authors providing this statement and research in the article, because while reading the article I can only think of the conflict of interest that has been established by those attempting to preserve the environment. If one has a vested interest in the outcome of the research, I find it hard to believe that the research is performed without bias.

Is Your Therapist an Expert?

Experts…at least on paper.

 

I was very impressed with the Jensen article. I appreciate the historical analysis of experts. To believe that an expert simply knew more and was able to solve problems better than anyone else is disheartening. I work with others that are certified in MDT and though we go about treatment strategies in similar fashions, we compete against each other with paper patients. One strategy that we use to refine our skills in a group setting is a version of 20 questions. One therapist will create a case study and each therapist is attempting to ask the fewest questions in the history section in order to create a hypothesis to solve the patient’s puzzle. Though there are varying degrees of experience in this group, the therapists that consistently attend the study group are typically able to solve the case puzzle within 3-5 questions, whereas others may take 10-20 to create a hypothesis. I agree with the statement that experts are able to recall meaningful, selective knowledge. I can appreciate the next generation, which describes recall of patterns. This is extremely important for orthopedics. Patterns take much time to learn, but once a pattern is consistently witnessed, the therapist can be confident in the treatment approach.

I find the “necessity of self-monitoring through self assessment” to be extremely important in my practice. The saying “if all you have is a hammer, then everything looks like a nail” comes to mind. There are many therapists that force extension because it is the most common pattern, although the patient may not be an extension responder. I have had to step back many times to reassess my rationale for a treatment approach in order to ensure that I am not just following a preconceived bias.

 

The fact that the therapists were videotaped is interesting. There is one point in the paper when the therapist changed demeanor from clinical to personal while doing soft tissue mobilization prior to traction. I wonder if the therapist was taught this somewhere along the educational spectrum or if this is inherent. This skill has to do with “reading” reading the patient. I am reading a book called Telling Lies by Paul Ekman in order to better understand body language. This therapist either learned or inherently knew to change the approach at that time. To me, this is interesting.

I subscribe to the paragraph on page 34, “The expert therapists in this study shared…”. This is a central component to MDt. At no point do we utilize the word compliance, but instead emphasize therapeutic alliance. In other words, a team approach to fix the patient, with the patient’s preferences, judgments, and decisions having as much importance as the clinician’s knowledge of the problem.

Bill Curtis, PT, cert. MDT lectured to our class about MDT and at the time I had a hard time believing that spine symptoms could be fixed in days. I called, pardon the language, bullsh_t. I spoke to Bill after the lecture and because he did not have any research to back his claims, I had a hard time believing him. That was the greatest thing to have happened to me as a therapist, because he challenged me to do a clinical with him. I learned more in the 8 weeks as to how to fix people than I ever did in school. At that time I knew that I had to work with him in order to continue learning the secrets to solving the puzzles. I see some of my colleagues struggling with spines, and think that I would’ve been in the same boat if I didn’t seek out a mentor with more experience and abilities than I had at the time.

I like the statement that the OC made “you made a lot of mistakes”. I actually feel bad for some of the early patients that I treated. It’s one of those situations that if I knew then what I know now. Some of those patient’s wouldn’t have needed 15-16 visits in order to be back to 100%.

 

I thought that it was common sense that listening to patients is vital for proper classification and treatment. Apparently I was wrong. This is a skill that has to be learned and practiced in order to master. When working with PT students, I ask them to follow along and just write down on the form the information and we compare forms after the evaluation. Initially, the students miss so much relevant information, but by the end of the clinical are able to catch all relevant information and information that may not be as relevant to the case as much as relevant to the patient.

 

It is interesting that therapists are classifying patients, although they do not classify formally. Anthony Delitto stated in one of his papers that a clinician will attempt to classify all the patients. The NC stated that he/she “form opinions pretty quickly about certain patterns” and the OC stated “I constantly try to make sense to see how certain clinical pictures behave”. At this point, they are initiating a rudimentary classification process. Also a strong theme in this paper is therapeutic alliance. It comes up many times in the article.

I like that the experts used little equipment and gave few exercises. I tell patients that I can give them a book of exercises to do at home or I can give them one or two that will fix their complaints, which I also learned from Bill.

 

All therapists “set high standards and were driven to stay current in their specialty area”. As much as I agree with this statement, this statement also disheartens me. As professionals, I would expect this mentality from all of my colleagues, not just “experts”.

 

I love this article and am not speaking to all of the points of the article, just those that I find interesting or of differing viewpoints than those taught in school.

The comment on page 41, “If expertise in physical therapy is some combination of knowledge…can clinical practice and education be designed in a manner to address these multiple dimensions of professional competence?” I think that the first question to be asked is does everyone desire to be an expert. The desire to be an example and set an example for other PT’s to follow has to come before attempting to teach the skill set of an expert, in my opinion.

 

Another great question posed was “Why do some therapists continue to develop into expert clinicians, while others lapse into mediocrity?” Can this be detected during the interview process for PT schools? This question is very thought provoking in that it may be possible to create a profession of experts if we choose the right students.

 

Again, I loved the article and found certain elements as basic, such as caring and compassion being cornerstones of experts, while I believe that the other concepts, indirectly described in the article, are intriguing.

 

 

Excerpts and opinions based on the following article:

Jensen GM, Gwyer J, Shepard KF. Expert practice in physical therapy. Phys Ther. 2000;80(1):28-43.

 If you are in need of physical therapy or would like to talk to a therapist about the benefits of PT, I am more than happy to accommodate. 

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