Medical journal's decision to keep controversial abortion paper sparks debate over editorial independence

A highly critiqued paper in the British Journal of Psychiatry has been cited in US legal cases to restrict access to abortion. Attempts to retract the paper by insiders at the journal have failed after the author suggested she would take legal action, leading to a row over editorial independence.

An investigation by The BMJ and BBC Newsnight can reveal that three of the journal's international board members have resigned after the journal and its owner, the Royal College of Psychiatrists, ignored the advice of its own internal panel to retract the paper.

The case raises questions about the use of scientific research in legal cases, the integrity of the research record and the editorial independence of journals.

The researchers who called for retraction have expressed concerns that the college has declined to retract for fear of being sued by the paper's author, raising questions about the journal's editorial independence from its owner and about the chilling effect of threats of legal action on scientific publishing.

The paper (Abortion and mental health: quantitative synthesis and analysis of research published 1995-2009) published in 2011, concluded that "women who had undergone an abortion experienced an 81% increased risk of mental health problems, and nearly 10% of the incidence of mental health problems was shown to be attributable to abortion."

The author is Priscilla K Coleman, who was a professor of human development and family studies at Bowling Green State University, Ohio, between August 2002 and June 2022.

Coleman has testified in at least 20 abortion related court cases, all in favour of greater restrictions on the procedure, and the paper was cited in recent US legal cases that restricted access to abortion, including the landmark US Supreme Court case Dobbs v. Jackson Women's Health Organization, which effectively ended the constitutional right to an abortion for millions of women in the United States.

Since 2011, 10 letters critiquing Coleman's paper have been published, including two calling for it to be retracted. They said the Coleman paper had significant methodological flaws that invalidated its conclusions.

In June 2022 a group of 16 researchers, many of whom had raised issues a decade earlier, wrote to the British Journal of Psychiatry again asking for the paper to be retracted. They pointed out that the analysis had been used to influence access to abortion in the United States. In December 2022 an internal panel convened by the journal to investigate the paper formally recommended that it should be retracted.

But after the journal contacted Coleman to inform her that an expression of concern would be added to her paper, her lawyers sent the journal a letter saying that such a notice would cause "serious harm and direct damage to her reputation." Coleman is currently suing the journal Frontiers after it retracted one of her earlier papers.

Four months later, in April 2023, the Royal College of Psychiatrists, which owns the British Journal of Psychiatry, decided not to retract Coleman's paper, but gave no scientific explanation for its decision, according to the researchers who had asked for retraction.

A spokesperson for the College told BBC Newsnight and The BMJ that the paper was "fully investigated between 2011 - 2012 by the-then BJPsych Editor, who decided that the article should not be retracted," and "the letters critiquing the article could be published and posted online with the article."

In a statement the College said: "After careful consideration, given the distance in time since the original article was published, the widely available public debate on the paper, including the letters of complaint already available alongside the article online, and the fact that the article has already been subject to a full investigation, it has been decided to reject the request for the article to be retracted."

Panel members Alexander Tsai at Harvard Medical School and Aileen O'Brien at St George's University of London think the journal couldn't act on their recommendation to retract the paper because it wasn't backed by legal cover from the college. They, along with another colleague, resigned from the journal's editorial board in May.

"A journal whose editors do not have the editorial freedom to retract science that is deemed unreliable is a journal that should be regarded by the scientific community as being unable to effectively police the quality of the science it publishes," Tsai told The BMJ.

O'Brien told Newsnight that the Royal College of Psychiatrists' behaviour was 'concerning.' "Usually you would have expected that to be an editorial decision," she said. "So at that point, those of us on the panel who'd been part of that investigation felt we had to resign; it didn't feel appropriate to stay.

"This isn't the way to settle science," says Chelsea Polis, a senior US scientist who led the call to retract. "Every decision about whether an article should be retracted should always be based on scientific considerations, and any aberration from that is a real disservice to the public."

Coleman disputes the methodological criticisms of her paper and says the researchers are motivated by a desire to discredit her as a researcher and an expert witness for political reasons. "My interest in the issue was to produce and synthesise high quality scientific data on a highly contentious topic for the ultimate purpose of effectively serving the needs of women," she told The BMJ.

The British Journal of Psychiatry's editor, Kamaldeep Bhui, passed the request for comment on to the Royal College of Psychiatrists, but has recently published a paper, which included Tsai and O'Brien as co-authors, about the importance of editorial independence of journals.

The Royal College of Psychiatrists did not address BBC Newsnight or The BMJ's specific questions about the level of legal coverage it held and whether this influenced its decision to overrule the recommendation for retraction.  

A spokesperson for the College said it would continue to encourage academics in this field to produce articles and papers that further the science on abortion and mental health, adding that it regarded this matter 'as closed.