I don’t know anyone involved in this story and don’t really have anything to add. I just wanted to post on it because it sits at the intersection of science, statistics, and academia. The New York State Psychiatric Institute is involved in a lot of the funded biostatistics research at Columbia University. Ultimately we want to save lives and improve people’s health, but in the meantime we do the work and take the funding without always thinking too much about the people involved. I don’t have any specific study in mind here; I’m just thinking in general terms.
Unfortunately, the article link appears to be paywalled.
This is a better article:
https://www.thetransmitter.org/ethics/exclusive-shake-up-at-top-psychiatric-institute-following-suicide-in-clinical-trial/
Tldr:
In a trial of levodopa (dopamine precursor used for parkinsons) given to impoverished people over 60 with non-severe depression and trouble walking (but no suicide risk), a subject in the placebo group died. Probably because they had to stop taking their antidepressant meds to participate. For some unstated resson that is standard practice in this field.
Some related studies were retracted because it was hard to get the participants to stay off their meds for a month to wash-out, so they included people who only stopped a day or week prior. It isn’t clear if a suicide during the appropriate washout period would have been reported as due to the study.
“Probably because they had to stop taking their antidepressant meds to participate. For some unstated resson that is standard practice in this field.”
Serotonin syndrome is a good example, where SSRIs and MAOIs can still be present simultaneously if there is no washout, leading to death. SSRIs are usually the first approach with medication. Several common SSRIs have long a long half-life, hence the washout period.
Quote from the blogpost: “Ultimately we want to save lives and improve people’s health, but in the meantime we do the work and take the funding without always thinking too much about the people involved. I don’t have any specific study in mind here; I’m just thinking in general terms.”
I think this is a very important topic, and hardly ever mentioned in my experience (for what that’s worth). I recently wrote and posted a manuscript in which I list some things I have wondered over time concerning Psychological Science. One of these things, I think, relates to the (gist of the) above quote. I hope it’s okay to share a section of that manuscript here:
“I wonder whether there are psychological scientists who think they have the knowledge, wisdom, and/or right to (directly or indirectly) “nudge” or “steer” people and/or societies in a certain direction (cf. Neuhaus, 2022). Do psychological scientist ever wonder whether they might make things “worse” (in the long term) when trying to make things “better” (in the short term)? Do
psychological scientists ever wonder about the potential negative consequences of certain knowledge they might help accumulate (cf. Popper, 1971, p. 283). I wonder whether psychological scientists that (directly or indirectly) help design and implement “behavioural interventions” are aware of the possibility that these “behavioural interventions” can have unexpected effects or even
opposite effects to those proposed and/or intended (cf. Stibe & Cugelman, 2016). If you are aware of the possibility of unexpected effects or even opposite effects to those proposed and/or intended of “behavioural interventions”, could and/or should you view the people that are affected by these “behavioural interventions” as participants in an experiment? Is there an “informed consent form”
that members of society have to sign before “behavioural interventions” that might affect them are implemented? I wonder whether it is currently the case that “(…) most scientists, at least most creative scientists, value independent and critical thinking very highly. Most of them hate the very idea of a society manipulated by the technologists and by mass-communication.” (Popper, 1971, p.283). I wonder whether psychological scientists think about the possibility that psychological treatments can cause harm, such as symptom worsening, the appearance of new symptoms, and excessive dependency on therapists (cf. Lilienfeld, 2007). I wonder whether psychological scientists think about the possibility of lasting negative effects of psychological interventions (cf. McQuaid et al., 2021). I wonder whether psychological scientists think about potential negative effects of psychotherapy in relation to informed consent (cf. Rozental et al., 2018, p. 309). I wonder whether the principle and/or perspective “first, do no harm” (primum non nocere) should receive much more attention in Psychological Science.”
Well that’s the problem with almost all research. In economics (my background), virtually all of the work I’ve done could be justified as attempting to do good – or could actually result in bad. Let’s be concrete – I’ve consulted for a variety of telecommunications companies. To the extent that my work has helped my clients, it rapidly becomes too complex to determine whether the “public good” (whatever that is) has been helped or hurt. I think most people are in similar positions – they have good intentions, but in reality it is hard to gauge the impacts they have.
Imagine the cases that seem clearcut: direct service providers, like physicians, clearly help their patients (at least when they do their best work), but given the prices they charge and the fact that other providers might have provided better treatment, it isn’t obvious that they have helped (though for most I’d say the net effect is positive). At the other end of the spectrum, thieves are not trying to do good, but they are trying to help their families and perhaps they are a perverted sort of Robin Hood. For most of us – working between those extremes – it is very difficult to really say whether we improve the world or not. The best we can hope for is to say our intentions were good.
Now for scientists: whether they do psychological research, statistical work, data science, nudges, school bus optimization, … they can’t easily tell whether they have improved things. So, the real question must be: what is their obligation concerning their research? I’ll just note that this is a very current topic for almost all data science work. How much must they consider potential negative effects? What mechanisms do we need to hold them accountable, and what should we hold them accountable for?
I have no answers. I do think this must be tackled differently in different disciplines. Medicine and Law have mechanisms (which can no doubt be improved). This is probably due to the obvious direct effect they have on their patients/clients. The hard sciences have some legal restrictions on what they can and cannot research. In social science, there is little I can think of – in fact, any self-regulation runs the risk of interfering with freedom of thought. I could easily be persuaded that this is a problem best left alone – sort of a caveat emptor for research. Until I start thinking about where that might lead….
Quote from above: “So, the real question must be: what is their obligation concerning their research?”
I can think of a few things, but they more or less involve some subjectivity and a particular view on things. But what I want to emphasize here, in line with this blogpost perhaps, is that it might be important to make researchers and members of the public aware of the possible negative consequences of things.
In this light, perhaps the main obligation of scientists concerning their research might be being aware of, and thinking about, these types of issues and types of questions. And in addtion, making other scientists and members of the public aware of, and think about, these types of issues and types of questions.
In this light, I hope it’s okay for me to share the more detailed references I used in the section I posted above for those interested:
Lilienfeld, S. O. (2007). Psychological treatments that cause harm. Perspectives on Psychological Science, 2, 53-70
McQuaid, A., Sanatinia, R., Farquharson, L., Shah, P., Quirk, A., Baldwin, D. S. & Crawford, M. (2021). Patient experience of lasting negative effects of psychological interventions for anxiety and depression in secondary mental health care services: a national cross-sectional study. BMC Psychiatry, 21, 578
Neuhaus, T. (2022). When push came to nudge – Interdisciplinary criticisms of behavioral (public) policy. New Trends in Social and Liberal Sciences, 7, 1-19
Popper, K. R. (1971). The moral responsibility of the scientist. Bulletin of Peace Proposals, 2, 279-283
Rozental, A., Castonguay, L., Dimidjian, S., Lambert, M., Shafran, R., Andersson, G. & Carlbring, P. (2018). Negative effects in psychotherapy: commentary and recommendations for future research and clinical practice. BJPsych Open, 4, 307-312
Stibe, A. & Cugelman, B. (2016). Persuasive backfiring: When behavior change interventions trigger unintended negative outcomes. Lecture Notes in Computer Science, 65-77
Anon:
Yes, this general issue came up in these posts from a few years ago:
Advice that might make sense for individuals but is negative-sum overall
Advice: positive-sum, zero-sum, or negative-sum
I have no issues with advice. It’s up to the person seeking, hearing, reading, or listening to the advice if they want to do all of this.
I do have issues with scientists nudging, or even steering people and things. I also have issues with scientists concluding things, or stating things, without enough nuance, or reservation, or careful wording, etc. And I have issues with scientists not thinking about how their own view of things might influence their research, thinking, advice, conclusions, writing, etc.
Anyway, the positive-sum, zero-sum, negative-sum posts reminded me of the parable of the Chinese Farmer which I like a lot and have quoted in some form on this blog before. This is one version of that story:
“Once upon a time, there was a Chinese farmer who lost a horse. All the neighbors came around that evening and said, ‘That’s too bad.’ And, the farmer said, ‘Maybe.’
The next day the horse came back and brought seven wild horses with it. All the neighbors came around and said, ‘Why, that’s great, isn’t it?’ And, he said, ‘Maybe.’
The next day his son, who was attempting to tame one of these horses and was riding it, was thrown and broke his leg. All the neighbors came around in the evening and said, ‘Well, that’s too bad, isn’t it?’ And, he said, ‘Maybe.’
The next day the conscription officers came around looking for people for the army, and they rejected his son because he had a broken leg. All the neighbors came around that evening and said, ‘Isn’t that wonderful?’ And, he said, ‘Maybe.’”
Reminiscent of this event: https://en.wikipedia.org/wiki/Death_of_Dan_Markingson
I was on the UM IRB at the time. It was a real shit-show.