Foundational Questions Regarding Peer-reviewed Journals

This blog relies extensively on the data and articles found in the peer-reviewed literature for cross-examining mental health professionals.  Consequently, at PsychLaw.net we feel it will be necessary for cross-examining attorneys to lay a foundation regarding the significance of peer-reviewed journals.  We recommend the following questions for foundational purposes.

1. Dr. X, you would agree that the practice of your profession can advance no further than the availability of the basic research to support it — Correct?
2. Just as the practice of medicine depends on basic research in the life sciences such as Biology and Chemistry, the practice of your profession depends on basic research in the behavioral sciences such as Psychology and Sociology — Correct?
3. And practicing professionals such as yourself are ethically obligated to maintain a working familiarity with the emerging research in your field — Correct?
4. [For psychologists] – Ethical standard 1.05 of the 1992 ethical code for psychologists – “Maintaining Expertise”^[1] – states:

– [read] –

“Psychologists who engage in assessment, therapy, teaching, research, organizational consulting, or other professional activities maintain a reasonable level of awareness of current scientific and professional information in their fields of activity, and undertake ongoing efforts to maintain competence  in the skills they use.”

Now my question: You are obligated to comply with this provision– Correct?

4. [For psychiatrists] – Section Five of the AMA Principles of Medical Ethics with annotations especially applicable to psychiatry, state:

– [ read ] –

“A physician shall continue to study, apply, and advance scientific knowledge, make relevant information available to patients, colleagues, and the public, obtain consultation, and use the talents of other health professionals when indicated.”

Now my question: You are obligated to comply with this provision– Correct?

AND

– [read] –

Provision One of Section Five: “Psychiatrists are responsible for their own continuing education and should be mindful of the fact that theirs must be a lifetime of learning.”

Now my question: You are obligated to comply with this provision– Correct?

4. [For social workers] – Ethical standards 4.01 (b) and 4.01 (c) of the 1997 ethical code for social workers – “Competence”^[2] – state:

– [read] –

4.01 (b) – “Social workers should strive to become and remain proficient in professional practice and the performance of professional functions.  Social workers should critically examine and keep current with emerging knowledge relevant to social work.  Social workers should routinely review the professional literature and participate in continuing education relevant to social work practice and social work ethics.”

Now my question: You are obligated to comply with this provision– Correct?

AND

– [read] –

4.01 (c) – “Social workers should base practice on recognized knowledge, including empirically based knowledge, relevant to social work and social work ethics.”

Now my question: You are obligated to comply with this provision– Correct?

4. [For marriage and family therapists] – Ethical standard 3.4 of the 1998 ethical code for marriage and family therapists –

“Professional Competence and Integrity”^[3] – states:

– [read] –

“Marriage and family therapists remain abreast of new developments in family therapy knowledge and practice through educational activities.”

Now my question: You are obligated to comply with this provision– Correct?

5. Familiarity with peer reviewed journals can assist a professional in maintaining a reasonable level of awareness of current scientific and professional information — Correct?
6. A peer-reviewed journal relies on a board of editors to review articles submitted to it for publication — Correct?
7. And articles submitted to a peer-reviewed journal are reviewed independently by at least three different editors — Correct?
8. And typically, editors reviewing the submitted article do not know who wrote it — Correct?
9. After reviewing the submitted article, each editor makes recommendations such as: publish as is — Correct?
10. Or publish with minor revisions — Correct?
11. Or publish with major revisions — Correct?
12. Or not currently suitable for publication — Correct?
13. And sometimes, resubmit with major changes and reorganization — Correct?
14. And sometimes editors conclude this article is not – and will not be – suitable for publication — Correct?
15. Peer-review, therefore, amounts to a valuable source of quality control regarding what is published in scientific journals — Correct?
16. The peer-review process encourages the publication of articles that make a significant contribution to your field — Correct?
17. And the peer-review process discourages the publication of articles amounting to “junk science” — Correct?
18. And authors of controversial articles, published in peer-reviewed journals, are ethically obligated to cite other articles taking a contrary position — Correct?
19. In other words, peer-reviewed articles are obligated to present a fair and complete review of the existing literature — Correct?
20. Articles published in peer-reviewed journals can therefore be considered generally recognized and accepted by your field — Correct?
21. And sometimes authors whose work appears in the peer reviewed journals, write chapters or books on the same subject — Correct?
22. And when these subjects, by these authors find their way into chapters and books, they can therefore be considered generally accepted by your field — Correct?

Because they are not as familiar with peer-reviewed journals as they should be, mental health professionals may attempt to diminish their importance. At ___ we feel you should consider, for example, the following exchange between a cross-examining attorney and a psychologist.

Attny:         Would you agree with the idea that your profession can advance no further than the availability of basic research to support it?

Psych:         I believe that my profession advances on the basis of basic research, but also advances on the shared community experience of skilled clinicians that come together to educate each other and to share their experiences and any relevant clinical information.

Claims such as these should be cross-examined in the following manner.

1. These “skilled clinicians who come together to educate each other” typically know each other — Correct?
2. And unlike the peer-review process of a journal, any criticisms expressed by these skilled clinicians – who come together to educate each other – are expressed on a face-to-face basis — Correct?
3. And considerations of future professional relationships could make it more difficult for these “skilled clinicians” to respond candidly and forthrightly to each other — Correct?
4. In other words, these “skilled clinicians” – coming together to educate each other and to share their experiences – may merely amount to you and your buddies talking about interesting cases over beer and pizza — Correct?
5. And there are substantial differences between formal peer-review, and you and your buddies discussing interesting cases over beer and pizza — Correct?

At PsychLaw.net we know that some professionals may also attempt to avoid acknowledging that peer-reviewed articles can be considered generally recognized and accepted by their field.  Consider the following exchange, for example; and most importantly, note how the cross-examining attorney persisted in obtaining the acknowledgment he sought.

Attny:         Do you agree that peer-reviewed articles can be considered generally recognized and accepted in the field once they go through that process? [referring to the peer-review process].

Psych:         Recognized and accepted how?

Attny:         As a reliable authority by practitioners or psychologists?

Psych:         Recognized and accepted as good enough to be published in a journal.

Attny:         To be relied on by professionals?

Psych:         Not necessarily.

Attny:         What I am getting at is if you see something that has been peer-reviewed, A – is it more likely acceptable material to the mainstream of psychologists, or B – is it more likely radical thesis type material on the fringe; which is a more plausible answer to that?

Psych:         A is a more plausible answer to that.

 

Mental health professionals typically protest cross-examinations that challenge their too often ill-informed opinions.  While protesting, they may offer anecdotal evidence or idiosyncratic experiences attempting to defend themselves.  More often than not, these attempts are less than responsive to the questions directed at them.  In particular, mental health professionals often attempt to deny, minimize, or rationalize the findings reported in peer-reviewed journals.  At PsychLaw.net we feel their attempts in this regard warrant the following sequence of questions to maintain control of the cross examination:

1. You understand that I am not interested in your unsubstantiated opinions — Correct?
2. Consistent with your ethical obligation to maintain familiarity with developments in your field, I want to know what peer-reviewed articles support your opinions — Correct?
3. And you do understand the difference between unsubstantiated opinion and peer-reviewed articles — Correct?

By now, you have noticed how most of our cross-examination questions end with the direct phrase, “Correct?”  We at PsychLaw.net have developed the questions in this manner to assist attorneys in maintaining control of the cross-examination procedure.  If given the opportunity, many mental health professionals will suggest why they regard various cross-examination questions as inappropriate.  Other mental health professionals may protest an approach that limits their answers.  Consider, for example, how a psychologist objected to this type of cross-examination:

Psych:         “You’re asking me about something that you have read and that I’m getting from you which is your, you know, synopsis of it.  I haven’t read it, and you’re asking me ‘Correct, correct.’ All I can say is this is what you’re telling me but I cannot tell you specifically anything about the article because I myself haven’t read it.”

Professionals who express these kinds of protests can be questioned in the following manner:

1. You previously acknowledged the significance of peer-reviewed journals — Correct?
2. Do you understand that when I refer to peer-reviewed articles, I will ask you to assume – consistent with a peer-reviewed article – that something is true. Do you understand that kind of question?
3. In other words, do you understand that when I refer to peer-reviewed articles in your field, I am asking you to hypothetically assume that something is true?
4. And when I end my questions by asking “Correct,” do you understand that I am trying to focus you on the issue on at hand?
5. You prefer to respond to my questions in a focused, relevant manner as opposed to an unfocused, irrelevant manner — Correct?

 Overview

Unlike other critics of mental health professionals, we at PsychLaw.net contend that these professionals can assist the legal process. When mental health professionals express opinions well supported by relevant data, they can assist a trier of fact to better understand issues in dispute.  Expert testimony premised on relevant research deserves respect from the legal system.   Expert testimony premised on intuitive hunches and ill-conceived theories, however, deserves well prepared cross examination to effectively discredit it.

 

[1].       American Psychological Association (1992). Ethical principles of psychologists and code of conduct.  American Psychologist, 47, 1597-1611.

[2].       National Association of Social Workers (15 August 1996). Code of ethics: Adopted by the NASW Delegate Assembly August 15, 1996, Effective January 1, 1997.  Author: Washington, D.C.

[3].       American Association for Marriage and Family Therapy (August/September 1998).  AAMFT Code of Ethics, effective July 1, 1998. , p. 10-11.