Ethical and respectful debate in scientific publishing

Robust scientific debate is vital for the advancement of knowledge in both mental science and psychiatric practice. When comparing opinions, disagreement is considered to be inevitable, but in reality, it is no less common in the interpretation of science, and thus controversy in scientific circles is more common than one is led to believe. Hence, it is no surprise that over the past decade or so, several controversial topics have featured in Australasian Psychiatry and in doing so generated papers with dissenting views. These have been published in the journal respectfully in order to present opposing views along with necessary justifications so as to allow the reader to have as much information as possible to enable them to reach their own conclusion regarding the ‘truth’. ¹ In this regard, the Editor has a critical role as referee and an equally important role in protecting the ability of authors to submit articles and to accept articles for publication without being influenced by large organisations, influential leaders or indeed their own personal views. To these ends, an Editor is constantly facing challenges but must hold true by maintaining scientific principles central to their decision making while fulfilling another of their key roles namely, facilitating ethical and deferential debate.

Ethical debate

One of the most common peer review comments is that ‘the conclusion is not justified by the results of the paper’. At a time when readers are time poor and may only read an abstract and the conclusion of an article, it can be misleading and potentially harmful to publish papers that list opinions alone rather than appropriately justified interpretations and arguments. In this regard, the emphasis that our College has placed on critical appraisal within the training program is apt considering the importance of being able to separate the ‘wheat from the chaff’ and to determine the truth when reading scientific publications and when responding to the lay public in response to media reports such as ‘Antidepressants don’t work’. ² In an era where information is easily accessible online and controlled by powerful media organisations, the imperative has never been greater to publish research that is scientifically sound and presented in the context of balanced viewpoints.

The ethical principle of justice guides an Editor’s need to remain impartial when it comes to ethical debates. Australasian Psychiatry has strived to publish papers predominantly on their merit rather than on the standing of the authors of the paper within the scientific community – though naturally in many cases the two often go hand in hand. This is part of the rationale for blinding authors’ names from peer reviewers. Views that oppose mainstream academic standpoints have been welcomed as long as they are based in reason and appropriately argued and that the publication of a paper with an opposing view ‘does no harm’ (primum non nocere). This principle needs to be sensitively considered for example, when publishing views for and against topics such as gender affirming care, climate change and mental health, the diagnosis of attention deficit hyperactivity disorder and the cost effectiveness of early intervention services.

Respectful debate

Scientific debate has evolved from a need to prevent undue influence from powerful entities exerting their versions of the truth without appropriate scrutiny, ³ and while we still need to critically appraise articles submitted for publication, we also need to carefully appraise what has been published and achieve some balance by accommodating opposing views if we are to genuinely refine and potentially advance our knowledge. An Editor cannot be seen to favour certain viewpoints and equally shouldn’t silence perspectives without good reason. Hence, just as a good referee knows how to keep a game alive while ensuring it is fair, a journal Editor must facilitate a rigorous and well considered debate that is both interesting and informative while still based in fact. The key ingredient that is essential in any debate is that of mutual respect, and it is the Editor’s role to arbiter and ensure that viewpoints are put forward respectfully and in a way that is not unnecessarily inflammatory, such as the use of language that is unduly critical or likely to cause embarrassment or distress. To use the language of Aristotle, we see some authors engage in rhetoric that places too much emphasis on pathos at the expense of logos and at the expense of the author’s own integrity or ethos. ⁴

Some authors can also exploit the uncertainty that comes with research in the field of Psychiatry with what has been coined by Freudenberg, Grambling and Davidson (2008) as ‘Scientific Certainty Argumentation Methods’ or SCAMs. ⁵ This is regarded as a politico-economic tactic that exploits the fact that most scientific findings are inherently probabilistic and ambiguous. Progress can be delayed until further evidence is gathered, and this may risk losing the benefits that may come from concepts or treatments that may be widely accepted by the scientific community. Examples include delays in vaccinating patients in psychiatric units or delays in recognising psychological harms associated with certain occupations.

Embracing technology

Although debate has occurred for centuries in the oral form, the advent of scientific journals has used the principles of argumentation and debate to document scientific positions that have been critically appraised by the peer review process and that are able to reach an international audience. Just as publishing led to a broader reach and increased permanency, the future of science needs to embrace new ways of communicating to add a further advance concerning the timeliness of communication without compromising on the quality of argumentation and scientific debate. Examples of initiatives that have attempted to improve the timeliness of scientific publication include online publishing ahead of print, continuous publication models, pre-print publications and acceleration of the peer-review process. Working on additional aspects, artificial intelligence is now being used by authors to assist the writing of papers; however, at the same time, it is helping editors and publishers, to screen papers for plagiarism and poor quality. Social media is also being used to broadcast science and scientific messages are now reaching a much broader audience and doing so within much shorter time frames.

By presenting scientific findings and arguments to large groups of people in relatively short time frames, our publications have the potential to have far greater impact than ever before. However, this means that we have an even greater ethical responsibility to ensure that what we publish is scientifically sound and balanced. Otherwise, editors and the journals they manage risk losing their standing, their integrity and ultimately their influence. This loss is not just the loss for an Editor or a journal, but it risks people turning to other influential sources of information that may not be bound by ethical conduct or scientific principles. For instance, download rates of articles may reflect the popularity of an article, but they do not necessarily reflect the value of an article for the scientific community – arguably it’s true impact. The citation rate also fails to effectively measure the success of an article in advancing a field of study and encouraging constructive scientific debate.

Conclusion

Scientific debate needs to be conducted in an ethical and respectful manner that embraces technology to advance knowledge and ultimately improve the quality of care that we provide our patients. Whether a scientist is an Editor, an Editorial board member, a peer reviewer or an author, they must strive to put the advancement of knowledge before any other interests, in a similar way to which we place the patient at the centre of our care models and treatment plans. A scientist must be prepared to hear an opposing argument and to then either refine their argument or to assist in advancing an alternative argument or common truth.

Cover Art

The cover art entitled Landscape of Consciousness is a work by psychiatrist Dr Kieran Forster and is about the nature of mind as a landscape. Dr Fortser has used oil, acrylic and ink on canvas. Many of Dr Fortster's works are about the coalignment of science and the humanities in psychotherapy.

PODCAST

In Conversation with Dr Ava Carter

Edward Miller – Trainee Editor, Australasian Psychiatry

Ashna Basu – Associate Trainee Editor, Australasian Psychiatry

Andrew Amos – Deputy Editor, Australasian Psychiatry

In this two-part episode, the Thought Broadcast interviews the RANZCP's Appointed Trainee Board Director, Dr Ava Carter. Dr Carter is dual qualified in dentistry and medicine, and is currently the consultation liaison advanced trainee and senior psychiatric registrar at Canberra Health Services in the Australian Capital Territory. Dr Carter has been involved with the College since beginning her training. In this podcast Dr Carter discusses her personal background, as well the nature and goals for her tenure as Trainee Board Director.