Thursday, 29 September 2011

Green Light for Compensation to Abused Swedish Foster Care Children

Late yesterday evening, the responsible minister, Maria Larsson, announced (here, here, here, here, here) that the victims of systematic abuses and neglect of the Swedish foster care system over many decades will, after all, receive compensation. The decision followed an agreement with the political opposition, after a former decision not to compensate had received massive criticism. My posts on that are here and here.

As the minister notes, the manner of compensation will be different than usual, e.g., by every victim being awarded a standard sum (250 000 Swedish kronor ≈ € 25 000). To some readers, the sums may look modest, but they are not in the Swedish legal tradition on monetary compensation for personal harm. Maria Larsson also notes that the decision is unique in that the state in this way is taking responsibility for activities run by local county authorities. However, at the same time, the solution is not very different from the one applied regarding compensation to victims of the forced sterilisation policy, where the notion of making a compensation that is proportional to each individual harm was rightly abandoned in view of the fact that such a requirement would make a compensation scheme practically impossible. True, such a solution departs somewhat from normal notions of justice in the area of compensating victims of unjust harm. However, as I see it, it errs on the right side, since it means that all victims receive a compensation rather than no one.

As harshly as I criticised Maria Larsson for her original decision, I must now congratulate her for having the political courage to change her mind and to reach an agreement with the opposition so swiftly.

Wednesday, 28 September 2011

Claim About Abortion Causing Mental Health Problems Falling Apart

The suggestion in an article in the British Journal of Psychiatry by researcher Priscilla K. Coleman that abortion causes mental health problems now seems to be rapidly falling apart. I voiced some doubts about the quality of Coleman's meta-analysis when posting about her article a while back, and it now seems that exactly the sort of basic faults that I worried about are present in Coleman's analysis. But it doesn't stop there. Two responses to Coleman's paper, both published in the BJoP, point out a number of rather grave deficiencies, and one may seriously wonder when the journal editor will start to think retraction. One may also wonder about the integrity and quality of the peer review process leading up to the publication of Coleman's article. Here are a few snippets of what the critics say:
Huge numbers of papers by respectable researchers that have not found negative mental health consequences are ignored without comment. Not surprisingly, over 50% of the "acceptable" studies she uses as her "evidence" are those done by her and her colleagues Cougle and Reardon. The work of this group has been soundly critiqued not just by us (1, 2) but by many others as being logically inconsistent and substantially inflated by faulty methodologies. As noted by the Royal Society of Obstetricians and Gynaecologists (3), the authors consistently fail to differentiate between an association and a causal relationship and repeatedly fail to control for pre-existing mental health problems. We note that she did not include in her articles the publication by Munk-Olsen et al. in the Jan. 2011 New England Journal of Medicine (4) that concluded that "the rates of a first-time psychiatric contact before and after a first-trimester induced abortion are similar. This finding does not support the hypothesis that there is an overall increased risk of mental disorders after first-trimester induced abortion". (Gail Erlick Robinson MD, DPsych, FRCP Professor of Psychiatry and Obstetrics/Gynaecology University of Toronto
Nada L. Stotland MD, MPH Professor of Psychiatry and Obstetrics/ Gynaecology Rush Medical College
Carol C. Nadelson MD Professor of Psychiatry Harvard Medical School)
This quantitative synthesis and meta-analysis did not follow the robust methodologies now generally accepted for systematic reviews[1]. There is no detail of the search strategy including search terms; the strategy is not comprehensive (only two databases included); other strategies to search the literature including citation tracking, hand searching and contacting authors and experts in the field to try to minimise publication bias were not carried out; and there was no assessment or rating of the quality of included studies, so that only those of at least reasonable quality are included in the meta-analysis. This is particularly important here as many of the primary studies included in this review have significant methodological limitations, including non-prospective design, non-standardised measures of mental disorders, lack of adjustment for pre-existing mental illness, lack of adjustment for other key confounders (e.g. social deprivation), non-comparability of exposed and non-exposed groups, and selection bias. [...]
Finally, the synthesis of the data and the summary statistics are flawed. The criteria for synthesizing data meant that several effect measures were included from the same study. Eleven of the included studies contributed more than one effect measure, with two studies contributing four measures each. Despite the clustering of effect measures by study, they are analysed as independent measures. This is an important limitation, since the use of several effect measures from a flawed study can magnify the bias. 
Most importantly for readers of this study to know, is the erroneous conclusions drawn by the author regarding the Population Attributable Risk (PAR). The underlying assumptions for estimating PAR include that there is a causal relationship between the risk factor (abortion) and the disease (mental health) and that there is independence of the considered risk factor from other factors that influence disease risk[8]. These assumptions are clearly not met in this review and therefore it is completely inappropriate to calculate a PAR from these data.  (Louise M Howard*, Hind Khalifeh*, Melissa Rowe*, Kylee Trevillion*, Trine Munk-Olsen†,
* Section of Women’s Mental Health, PO31, Institute of Psychiatry, King’s College London †National Center for Register-Based Research, Aarhus University, Aarhus, Denmark)
The first of these critics also point out:
 Reardon, the leader of this group, has clearly expressed his new rhetorical strategy as "we can convince many of those who do not see abortion to be a "serious moral evil" that they should support anti-abortion policies that protect women and reduce abortion rates" (5) . He has stated that "I do argue that because abortion is evil, we can expect, and can even know, that it will harm those who participate in it. Nothing good comes from evil." (6). These authors have a clear agenda and publish a steady stream of papers, based on faulty methodology, designed to prove their point. If we and other researchers know this, how is it that reviewers for esteemed journals such as yours consistently fail to recognize these deficiencies and biases?
In short: Coleman and her group has an established track record of faulty, sub-standard and biased research. The article in question has applied faulty methodology on several counts, some of which is so obvious that even a happy amateur like myself could spot it. So, dear editor of BJoP, how come that this article could sneak through the peer review process? How was peer reviewers selected, for example?

Monday, 26 September 2011

SNS Managing Director Anders Vredin Resigns

Today, the board of the Centre for Business and Policy Studies (SNS) announced that they have agreed with managing director Anders Vredin that he will resign his post as soon as a suitable replacement is found, and that the search for such a replacement is to start immediately. Media reports can be found here, here, here, here, here. Effectively this means that Vredin has been sacked.

Given the events of the last week or so, this development is expected. The affair, as well as my posts on the issue, started when Vredin issued a gag order for the (now former) SNS head of research, Laura Hartman when she wanted to respond to criticism of a report pointing to the weak empirical evidence for repeated claims that a long trend of privatisation of Swedish public services improves effectiveness, which led Hartman to resign. After that followed a storm of criticism of Vredin, further resignations and threats of such from all parts of the SNS leadership and scientific advisors. Vredin did a weak attempt to roll over publicly, but instead exposed himself as harbouring exactly the sort of lack of support of academic freedom and research integrity that critics acused him of having acted out of. The Swedish academic community in general has also reacted strongly against Vredin's actions. My posts on this process can be found here, here and here.

The decision of the board today was simply the only one they could make, lest SNS would very quickly have been history. It remains to be seen, however, if trust and confidence in SNS research can be rebuilt. At least for me, it will take quite a while of unquestionable behaviour before I can start to feel reasonably certain about results and reports coming out of SNS not being screened, edited and censored on other grounds than purely scientific ones. One thing one would like to see in that process is that SNS research is more systematically being exposed to critical scrutiny of the international scientific community, thus not primarily publishing reports in Swedish only, but base these on peer reviewed articles in established research journals.

Saturday, 24 September 2011

The Philosophy of Hate Crime Symposium

On Monday and Tuesday the coming week, I and my colleague David Brax, will be hosting the 2nd European hate crime symposium, arranged within the EU project When Law and Hate Collide, on the theme The Philosophy of Hate Crime. The program of the symposium can be viewed here (click pic to enlarge):

During the two days of the symposium, a hand-picked collection of international scholars and experts on the underlying philosophical and ethical issues actualised by the phenomenon of hate crimes and the challenges of designing hate crime policy will present their views. They will, furthermore, discuss with us in the project basic such issues related to the challenge of designing an overarching European hate crime policy with regard to criminal law, monitoring, prevention and public awareness. The symposium will be documented by the University of Gothenburg TV and audiovisual department, for eventual broadcasting through Swedish TV and the internet.

During the symposium, you can follow the action on twitter, using the tag #H8Crime

While waiting for that, it may be of some interest to watch some of the footage done at our first symposium, held in Strasbourg this spring. Below, you find some of the presentations plus a part of the roundtable discussions we had with interested members of the European Parliament (this video has some image damage at the end, but the sound is clear all way through).

1. Anthony Mark Cutter & Keiran M Bellis: Introduction and overview of the European hate crime situation

2. Paul Iganski on what is bad about hate crime

3. Paul Gianassi on the UK law enforcement approach to hate crime

4. Alke Get on German hate crime policy

5. Nathan Hall on what hate crime is and may be

6. Sylvia Lancaster on the Sophie Lancaster hate crime case, and the issue of the scope of hate crime policy

7. Excerpt from roundtable discussion of hate crime, policy concerns and research needs with members of European Parliament

Seven Members of the SNS Board of Trustees Demand the Resignation of Managing Director, Anders Vredin

The sad circus of the inability of the leadership and management of the Centre for Business and Policy Studies (SNS) to stand up for elementary standards of scientific freedom and integrity against vested interests continues. My former posts on this affair are here and here.

Today, seven members of the SNS Board of Trustees – attached, among other things, to ensure that not even the proverbial wife of Caesar is suspected of things like the ones revealed in this affair – publish an article in my country's leading daily. They recount in astute terms the core of what this business is about, the faults committed, what is at stake for SNS and conclude by, in so many words, demanding the more or less immediate resignation of managing director Anders Vredin. Yesterday, Vredin made a sad attempt to put the toothpaste back into the tube, but as I described in my post on that, when reading what he actually says in that statement, it rather conveys the impression of a person that, albeit flagging academic credentials, a long time ago lost his moral compass when it comes to basic values of the research and scientific community.

The SNS board of trustees, it may be added, is no light collection of people. It hosts leading and very well-respected scholars and researchers in the academic fields often figuring in the projects of SNS, such as political economy and history of ideas – several of which are held in high regard, not least for their demonstrated high standards of integrity in relation to business and political interests.

Friday, 23 September 2011

SNS Director Pathetically Attempting to Roll Over on the Silencing of Controversial Research After Harsh Criticism from Scientific Advisory Board

Over just a few days, the sad affair of the Swedish private enterprise run thinktank-wanting-to-be seen-as-a-serious-research-institution Centre for Business and Policy Studies (SNS) that I posted about just the other day has taken another turn. First, yesterday, the scientific reference group that critically assessed the report of Laura Hartman issued a statement of which it is worth quoting a tasty chunk (in my translation):
 ...It is remarkable that such ambitious societal reforms have been undertaken without a simultaneous development of systems to monitor and evaluate the results of making the production of certain public services occur in a context of market competition. It is a considerable merit of the SNS-report is that it pinpoints these failures in the oversight and systematic evaluation of producers, private as well as public ones.

Then, today, the scientific advisory board of SNS released an unanimous statement harshly recounting the serious faults committed by the SNS management in this affair and demanding that the SNS direction and board immediately take action of three sorts: (1) to issue a statement where they, without qualification, express their support of scientific freedom, (2) express serious and honest regret over the faults committed in the handling of the case in question, and (3) openly commit themselves to promptly develop and make public a transparent and clear policy for to the effect that similar faults are prevented in the future. Of course, the underlying message is, "or we resign our posts", and that would indeed be the irreversible end of SNS.

The same day – today – the managing director of SNS, Anders Vredin, issued a public statement with the headline "I Acted Wrongly" – reported also here, here, here, here, here, here, here). Presumably, this statement is the first step in an attempt to accommodate the demands of the scientific advisory board. However, this attempts not only comes too late to be credible, it reeks of insincerity and unwillingness to recognise what is at stake. The most astonishing formulation runs like this:

Intending to stimulate a broad discussion with no holes barred with regard to the important issues of fact and analyses of the report [...], I did not want to allow Laura Hartman to actively participate in the debate.
He then goes on, in the best spirit of a religious dogmatic leader to profess:
...the decision was based on my own conclusion that there were defects in the SNS-presentation of the report. Defects that I should have noticed much earlier. Thus, the responsibility is mine.
So, in short a broad and unprejudiced debate on a research suggestion is best accomplished by banning the maker of this suggestion to participate in the debate. And when a popular presentation of a research report is faulty, the best remedy is to stop the one actually knowing the content of the report best from voicing her opinion. And the best of all: Anders Vredin "concluded" that the report was defective before said debate had even been conducted.

My – humble – conclusion is this: the ball is now with the scientific advisory board. If SNS can display nothing better that Vredin's pathetic excuse for behaving like a bought and paid for pawn, the scientific advisory board must show its hand. For, in light of Vredin's more than lame response to its call, the question must now be asked where the loyalties of this board lie. Is it with the opportunity to be cuddled by vested interests displaying impressive funding muscles if only you don't rock the boat, or is it with real science and real research?

It's up to you to make the choice.

Thursday, 22 September 2011

Pharma Corps put Money Before Swedish Women's Health, But Why Be Surprised?

Today, the Swedish branch of the international pharma corporation GlaxoSmithKlein (GSK) announced that it will appeal the decision of the united health care regions of Sweden to use the vaccine product of their competitor Sanofi Pasteur MFD (SP), Gardasil, over GSK's Cervarix. The decision is another stalling maneuver in a longwinded process following the decision of Swedish public health authorities to provide young girls and women with a publicly run vaccination programme against Human Papillomvirus (HPV) – causing both cervix cancer and STD's, such as condyloma. It is unknown how long the processing of the appeal will take, but the financial director of GSK in an interview alludes to an earlier court process (see below) that took about 18 months. Thus, due to GSK's decision today, during this time-period potentially all Swedish young females will be provided with no protection against HPV. Possibly, some of these will buy a vaccination with their own money, but that can hardly be credited  as an upside to GSK's decision, given that they could instead have received it for free.

However, this is not the first appeal in this story. In fact, the decision that GSK is now appealing is the result of a former appeal that SP made against an earlier decision to purchase Cervarix. Also in that case, the material effect of the appeal was endangerment of many, many young women's health. Both companies of course argue that their product is the best, but that's just smoke. What they do is to repeat their sales pitch, but now publicly rather than in the original business bid. In the case of GSK, they even have the poor judgement and tasteless arrogance of trying to present their bid as objective argumentation in a debate article. Come on! The assessment of these bids is the business of the buyer, and if the buyer makes a bad decision, that's where the responsibility is to be placed. However, the buyer of a large public health policy order has many things to balance. Of these the effectiveness of the product is, of course one. But effectiveness is a complex matter and in the case of HPV very much so, since different strands of HPV link to several different health problems. In addition to that, the expected effect has to balanced against the cost. This since, at the end of the day, every Swedish Crown spent unnecessarily is a crown that could instead have been spent on other important public health undertakings. Given this situation and given that all information from the bid-makers have their basis in the self-interest of a business organisation (which in the case of becoming a part of a large public health undertaking is huge), the argumentation like the one presented by GSK today is simply not credible. Of course, they have to say that they believe in their product, just as SP has to. But so what? Regardless of this, the buyer has to make an assessment and a decision. What the appeals create is only that this procedure has to be done all over again, the first time by the buyer (according to procedures prescribed in Swedish administrative law), and this last time by a court of law. In neither of these cases will the repetition of GSK and SP of the claim that their product is the best one mean anything. The whole process is so absurd, that the responsible politician for the process of buying the vaccine, Stig Nyman, today urges the government to change the regulation around purchase of health products by the public sector, so that the armies of lawyers of the pharma corps are barred from obstructing orderly processes of great benefit of the public to proceed. Similarly, in Sweden's foremost politically conservative news paper, Svenska Dagbladet, otherwise notorious for its overly charitable interpretations of the intentions and doings of private enterprises, the deadly outcome of GSK's decision is underscored and the analysis is made that the pharma area of business is in fact nothing but callous, inconsiderate and deceitful.

Now, GSK has realised that the decision to appeal yet another time does not put the company's image in a very good light and therefore tries to give an impression of having taken the decision greatly troubled and burdened by ethical considerations. All pharma corps nowadays do their utmost to project such an image of caring about the health of people and minding about ethics, and GSK is no exception. However, is this more than mere branding (a question that applies to SP  just as much, of course)? One of my department's most successful young researchers, Joakim Sandberg, wrote his PhD dissertation Ethical Investing: Making Money or making a Difference? (and numerous papers) on the issue of how much the projected interest of being "ethical" used as a marketing tool by companies in different branches (using the case of investment funds) is grounded in any substantial ethical commitment. The sign of such a commitment is double: (1) that the company has a clear, publicly accessible and plausible idea of the criteria for acting ethically defensible (most of the book is about what that implies) and (2) that this idea at least sometimes is actually motivating the company to make decisions that are less than optimal in business terms. Simply put, if you are not prepared to sacrifice anything for your ideals, you effectively have no ideals. Not surprisingly, perhaps, it appears that the examples of business operations projecting the image of being especially ethical and at the same time meeting condition (2) is a rare species indeed.

In the pharma area, there are numerous examples of this phenomenon. In fact, the list of cases is becoming so long and depressing that the mechanical repetition of the public relations departments of all of the pharma corps around the world that good ethics is a key endpoint of their enterprise is starting to sound like the gibberish of a mad clown who no one think is funny anymore. Just a few years back (before I started this blog, or you would have read about it here), Astra-Zeneca was exposed in a major research ethics scandal,  where they had deliberatly chosen to conduct a clinical trial of psychiatric drug in a country (Russia) that insisted on a placebo arm of the trial, although an existing efficacious treatment was in place. In effect, half of the participants were left with no rather than some treatment and a number of suicides had to occur before A-Z had the sense to abort. What is more, they did this not in order to have a license for the drug in Russia, but to have it in the EU. I and several bioethics colleagues in my country had no problem in harshly criticising A-Z (here, here) and the lame response from A-Z was that they indeed were an ethical company, since they had abided by Russian research ethical regulation - thus pretending that they carried no responsibility for having chosen (obviously for economical reasons) to house the trial in Russia in the first place. This is just one among many, many cases of what in bioethics circles has become known as clinical trial imperialism. Simply put, Western pharma corps systematically try to place their trials of new drugs in countries where the trial will be most cheaply run while still providing results that may get them a license somewhere in the West. As to upholding minimal standards of human subjects protection, reliable oversight and accountability – sod that!

So, to get back to GSK, SP and the HPV vaccination business. What we see happening in this case is just more of the same. Sweden just like all other Western countries are using tax payers money to provide pharma corps with very privileged positions: patent systems, drug subsidises, seed money to ease the establishment of offices and labs, access to the resources of medical schools, university hospitals and public health care systems, close cooperation to smooth the product development process, and support for a market for non-prescription drugs that in most cases actually is detrimental to the health of the population. They do all that because they see no alternative. The development of new pharmaceuticals for serious and widespread disease is a high risk endeavor and very expensive process, and most countries prefer to have it done with the funding accessible through business transactions. But this is no reason to be seduced by their marketing offices. Pharma corps don't care about anyone's health and even less about public health. In fact, the best business sitiuation for a pharma corp is a permanent health problem that never goes away, but where the company can supply a product that slightly mitigate the symptoms. That's far, far better business than anything that cures people or – to name the nightmare of a pharma – that permanently prevents the onset of the problem. Even less do they care about ethics or upholding minimally decent ethical standards. They demonstrate this convincingly by never ever being prepared to sacrifice a buck for adjusting to ethical considerations of any weight. They do, of course, abide by laws, but prefer to place production in countries where efficient industrial operation is combined with the most allowing rules – unless sale efficiency demands otherwise. They do, on homepages and in company prospects, repeat the words "ethics" and "ethical" (as well as "responsible") so often that the cursory reader might mistake them for something out of the Vatican, but, as the Swedish case of GSK and SP regarding HPV vaccination shows, all of this is smoke and bogus. All. That is not a very comforting thought, and in light of our view of pharma corps as necessary, that discomfort may trick us to believe otherwise. But this is, I claim, the sole truth.

Wednesday, 21 September 2011

A Lysenko Affair in Private Enterprise Sponsored Research

Today, the social science research community of my country is shaken by a scandal of groundbreaking magnitude. The private enterprise sponsored research institute, Centre for Business and Policy Studies (SNS), just a few weeks ago made public the results of an impressive study of the outcome of the trend of privatisation of public services in Sweden that has been going on for over 20 years. Since SNS is often seen as an ideology-producer for the Swedish private enterprise community, it was both surprising and refreshing to read project leader Laura Hartman's impassionate summary of the study, the main result of which is that the privatisation trend can, in fact, not be shown to have lead to any gains in the effectiveness of public service (here, here). In particular, Hartman highlighted the lack of empirical support of the often mechanically repeated hypothesis that market competition in the realm of public services leads to increased effectiveness.

Not surprisingly, the results provoked debate. In fact, it seemed to create a virtual panic among the lovers of the idea of a sell-out of public services. The reason, of course, is that while the core fans of this idea support it either for libertarian reasons or for the self-interested hope of making a quick buck in the process themselves, the support of the general public of such reforms is heavily dependent on the perception of them as promoting the common good.The results are especially sensitive in view of the programme of the current Swedish right-wing government's open plans to continue and increase the pace of privatisations – repeatedly motivated by arguments in terms of making public services more effective. Nevertheless, on the SNS website, the results are clearly set out and a sketch of a continuation of the programme can be found (alas, only in Swedish).

Today, however, SNS announced that Harman's contract has been terminated "on her own request" to pursue research at the department of political economy at Uppsala University (to which she has been affiliated since before) (here, here, here, here, here, here, here, here, here, here to name just a few). In the political magazine, Arena, Hartman reveals what "her own request" stands for (my translation):

When I took the job at SNS, I had a clear view of how the research should be conducted and how the presentation of the results should be undertaken. I have now come to a point when I realise that my opportunities to do what I envision are better in the university sector. [...] I believed that I would have the opportunity to present and discuss my results. I was allowed to do that at the conference [where the report was presented] but not after that.
[Interviewer:] Was this a gag order being issued?
 I don't want to comment on that. It suffices to note that I experience my opportunities to conduct and discuss my research as better when done from Uppsala University.

Could anything said between the lines be more loud and clear? And as if that was not enough, just a few hours later, long-time associate and former Director of Research at SNS, Professor of Political Science Olof Peterson, announced on his blog that he immediately severs all connections to SNS. The given reason is that (in my translation):

Internal disagreements regarding the right of researchers of SNS to present the results of their research freely. [...] On my view, it should be self-evident that SNS does not restrict this freedom of SNS affiliated researchers. However, it has now come to light that the directorship of SNS have acted in a way that violates academic freedom. Therefore, I resign my position at SNS.
In sum: what we seem to be watching is a bona fide Lysenko affair, but now in the realms of private enterprise sponsored research, rather than the communist, plan-economical original. The only difference is that the uniform of Stalin has now been replaced by the double-breasted pinstripe suit of the business executive and his spin doctors in media and politics. Stalin so much wanted his impossible five-year plans for Soviet agriculture to be feasible that he sacked and destroyed the lives of any scientist questioning the thesis of Lysenko that crops could be made to acquire hereditary features such as resistance to cold by being exposed to environmental conditions such as low temperature (which, if true, could have made Siberia bloom). The SNS directorship and its sponsors so much wants the privatisation programme to be possible to sell to the voters without lying, that it issues a gag-order for any affiliated researcher undermining that scenario.

My own conclusion is this: First, private enterprise sponsored social science research is far, far, far more of a problematic entity than has previously been acknowledged. Second, SNS must either immediately roll over about five times on this issue, lest it loses all the credibility as a serious research institutions that it has worked hard for several decades to build. Third, to all international colleagues: next time you see a Swedish research result in social science or economy, better first check that it is not ordered, bought and paid for by SNS! Fourth, Laura Hartman and Olof Peterson deserve unlimited praise for their integrity and courage. Even if you are well-established, resigning your institutional affiliation is not a light thing in the world of academia. To Olof and Laura: You give me inspiration for and hope about doing the same, should I ever be unlucky enough to find myself in such bad company as you have been cursed with.

To SNS: We all see the nakedness now. Perhaps time to resign from the imperial throne and be more honest, don't you think? Looking forward to see the announcement of an imminent reorganisation into the Private Enterprise Bureau of Ideology and Propanganda. In Swedish, Studieförbundet Näringsliv och Ideologisk Propaganda (SNIPPA).

Monday, 19 September 2011

Should Names of Swedish STASI- Collaborators be Revealed?

This year, a continuing debate in my country has concerned a list of names of Swedes, extracted from a part of the DDR (a.k.a. GDR or East Germany) secret police, STASI, archives, that somehow drifted out of Germany in connection to the dismantling of DDR and in some way or another found its way into the hands of the Swedish Security Service (SÄPO) The list is supposed to contain names of certified STASI collaborators, although SÄPO officially maintains that none of them have been found to be bona fide spies, albeit some of them possibly potential active agents against other countries (primarily West Germany). To the extent that people on the list could be said to have engaged in criminal activity, these crimes have passed the time in the Swedish statute of limitations when they are no longer possible to prosecute, SÄPO maintains.

For some time, journalists and researchers have tried to access the list and the associated files, while SÄPO has insisted on restricting the access due to national security, the integrity of SÄPO activities and concern for individuals. June 24 this year, the Swedish Supreme Administrative Court decided to order SÄPO to make the records in question accessible to professor Birgitta Almgren. However, the order was surrounded by qualifications, among these that Almgren was not allowed to identify the individuals on the list. Just recently, Almgren published a book (only in Swedish so far) where she reveals generic facts about the people on the list – stressing not least the point that there is more ways of being an agent for a country than being a spy. At the same time, apparently, the list has leaked and found its way into the hands of various journalists, who have started to argue that the reasons for protecting the identities of the individuals on the list are bogus – or at least not obviously strong enough to trump the public interest of letting the detailed information become widely known. Part of the argument is about that even if only a handful of the people on the list did things motivating suspicion of criminal activity, many of them seem to have collaborated with STASI in other, less criminal or draconian, ways – such as influencing the view of the DDR in Sweden, especially in the higher levels of official society. On the list, Almgren's book reveals, are names of not only politicians or interest organisation representatives, but also researchers, educators, journalists, politicians and business-people. Another argument is more about the general need for Sweden to relate itself realistically to the era of the Cold War, in the same way as the many sides of Sweden's famous neutrality policy towards the US and NATO has been detailed in later years. SÄPO, however, resists the call for transparency, insisting on the reasons given above.

There is a basic problem with trying to assess the competing sides of this debate in that SÄPO, true to its position (and maybe its nature), does not reveal any details supporting its claims. Almgren, on the other hand, make opposing claims on the basis of the records she has been allowed to access, but an outsider has troubles assessing the validity of her position, since the raw data are not available to anyone else than Almgren. That is, as long as we do not consider the claims of those journalists and debaters who claim themselves to have access to these data (i.e. the list). Looking at this situation with the calm and disinterested eyes of a researcher, it is hard for me to avoid the conclusion that neither side has - to this day - presented much reliable evidence. At the same time, the sole cause of this is the insistence of SÄPO to keep access to the files restricted.

Now, if we could be certain about the position of SÄPO being a result mainly of the "natural instinct" of any security or intelligence organisation to keep everything a secret, it would seem that the argument about the generic need of making this part of Swedish history clear would be a rather strong reason for SÄPO to reconsider its position. However, since SÄPO does not reveal any details, we cannot know that this is the case. There may be a national security interest in keeping the names of the collaborators hidden from the public eye in numerous ways. The most obvious are that these people may just as well have been double agents, or that they are presently active informers of SÄPO in virtue of their past experiences – in both cases, this means that the files may indirectly reveal details about SÄPO's operational methods. SÄPO may also be right in its argument about protecting innocent people against public embarrassment on false grounds, at least in some cases. The problem, of course, is that there is no way to reliably evaluate these arguments, since the evidence is kept under lid. And, again, the same holds for the claims of those debaters who maintain that SÄPO's reasons for continued secrecy are bogus.

On the basis of this, I make four general observations:

First, one part of the problem here seems to have to do with the need for public trust in public agencies. Security and Intelligence agencies are especially in need of this, since so much of what they do and how they do it is hidden from the public eye. Such agencies, it may be said, constitute a special section of the imagined social contract of any country. This means that, for better or worse reasons, if a process of distrust is initiated by some operation of such an agency, as this process becomes more powerful, it also becomes a continuously better reason for this agency to revise the operation in question. In fact, this can be claimed to be a central task of any agency: to act in such a way that maintains its legitimacy.

Second, another part of the problem is that – apparently – the secret list is not such a big secret as it used to be anymore. Besides Almgren, it appears that several journalists and the tabloid Expressen has hold of it. The latter has the last few days started a series of articles detailing the individuals on the list (here, here) – immediately provoking responses of denial from two of the accused. No names have been given so far, but the articles are as close to identification as you can get without revealing identities in a formal way. This obviously creates a problem for SÄPO, both regarding its claims about need for continued secrecy and its trust among the public. However, it also underscores SÄPO's argument about protecting innocent individuals from disproportionate public embarrassment. In view of the passionate denial, we have reason to ask also about the soundness of the reason for making this information public in the way that it is done. It appears that we may have cause to distrust the reasons not only of SÄPO, but also of the media, in this case Expressen. Is this campaign really only about making history clear? Doesn't it smell just a little bit of the vigilante mentality of making the bad guys pay – getting back at them in the only way currently possible?

Third, while the argument in terms of the need to make clear Swedish history in these respects is a valid one, it does not follow that the time to do this is while these people are still alive. Where we are standing now, we have no way of knowing with any certainty the substance of the detailed claims made by either SÄPO, Almgren or Expressen. The only way of achieving such certainty is to have open access to the relevant evidence. But such access, as may be exemplified by the latest developments due to Expressen's articles, may be used for furthering a lot of other, less honourable, agendas as well. In effect, it creates a new uncertainty, but now the doubt targets the press rather than SÄPO. In addition, the risk of unnecessarily harming individuals for no good reason seems to be real. So, in consequence, why not wait for a while? What is the hurry? As much as I sympathise with Almgren's project and the general agenda of making important historical facts known to the public, this is not the only thing that matters. And, to this day, I have seen no good arguments for why secrecy should be lifted before the persons on the list have indeed become historical persons.

Fourth, this last point actually reveals a rather serious research ethical argument that may not be apparent at first glance. One response to the just said would be this: if we are going to have a clear picture of this historical phase, we need to be able to talk to the individuals involved. This is an impossibility given the currently valid court decision on this case (Almgren is forbidden not only to give names, but also to contact anyone of the people on the list). However, let us play with the scenario that the list is made public, in what position will this put the people found in the files? We can be certain that the press will have a field day. We can also be certain that researchers wanting to investigate the area will not hesitate to publish details from the files also when the individuals decline any participation in a study. In other words, the offer being made to these people will be: "Have your say in my study, in the context of all the bad things the press is saying about you, or the details on file about you will be revealed without your comments and explanations attached". While not constituting direct force or coercion, it does come daringly close and I, for one, would hesitate to OK a study on such premises.

So, what is my final verdict? I'm still uncertain, but I tend to lean towards the view of doubting the urgency of publicity, while at the same time seeing that SÄPO is in a position where its arguments for maintaining secrecy are gradually becoming weaker. What I do not support, though, is any simplistic black-or-white view of this matter. Not least the research ethical complexity created by immediate and complete publicity should worry researchers a bit, and the news media seem to have reason to revisit and scrutinise their reasons for publication.

Saturday, 17 September 2011

Approaches to Preventing Hate Crime

This piece connects to two former posts (here and here), actualised by my participation in the project When Law and Hate Collide: Perspectives on Hate Crime, meant to produce a basic ethical, theoretical and factual framework for harmonising various aspects of European hate crime policy. My Swedish colleague in the project, David Brax, also has a series of posts linking to this project at his blog, Brax on Philosophy.

My former post was about the concept of hate crime – or, since the term "hate" is not really a good one: bias crime as many are starting to call it – and how it connects to the concept of human rights. That post, like so many opinion pieces connecting to hate crime, suffers (at least a bit) from a tendency to be seduced by the word "crime". This word makes us immediately think about criminal law-making, court proceedings, police-work, punishment, and so on. And those aspects of a policy addressing the phenomenon of hate crime are, of course, important. However, if you think that hate crime is a serious matter – serious enough to motivate special legal provisions, at that – you should in fact be more interested in another aspect, namely, what a good preventive policy related to hate crime should look like.

Now, since I am a philosopher and ethics researcher, what I have to say about this will not be very hands on or immediately practical. It will, however, be of interest for those pondering more concrete preventive issues connecting to hate crime and possessing the qualification for doing that in a good way. What I will do, is to set out four different approaches to how one may go about pondering such issues – within what theoretical frames and assumptions the development of preventive hate crime policy strategies may proceed. I will present four such frameworks for preventive thinking in this area, and then conclude by pointing to some important ways in which these frameworks connect and may promote each other.

1. Effective General Crime Prevention
As explained in my former post, hate crimes are not a special type of crime. Hate crimes are ordinary crimes with an additional element: the occurrence of the crime is connected to some sort of factor signalling that the perpetrator commits the crime in conjunction with holding or expressing a particularly biased or disparaging attitude or view towards the victim in virtue of a perceived membership of this victim in some particular social group. This immediately implies that an obvious strategy of prevention as regards hate crime is to effectively prevent crime in general.

Now, many people believe that there is a connection between retributive responses to crime and the occurrence of further crime, and that may very well be so. At least in the individual case, if a perpetrator of a crime is sentenced to imprisonment for some time, this person will not have much opportunity to commit further crime while locked up (at least not outside of prison). However, it is also well known that such retroactive individual prevention strategies are a rather minor part of the tools available to a society that wants to reduce crime rates. Philosophers of law and punishment have often pointed out that, as a matter of fact, such reduction is probably most effectively reached by simply de-criminalising some of the most common crimes. While this is a logically valid point, I will, however, not consider it further here, since it so obviously misses the point about crimes that they are considered crimes due to some reason; for instance, that they tend to seriously harm people. Still, the philosophical point helps us to see that there are other ways of thinking about crime prevention than merely reflecting on fitting responses to people who commit crimes. Instead of becoming caught up by the individual case, where the idea of prevention is practically applicable only once we know that we are dealing with a person to some extent likely to perform a criminal act, we can think about prevention on a more overarching scale, in terms of general factors that appear to be linked to the general frequency of crime in a society.

There are several factors of this type that are well-known. One, of course, is the level of poverty, destitution, and similar conditions. Another factor that has been highlighted more recently through the book The Spirit Level, is social inequality. A further, very important factor, is the level of legal security and quality of government – the latter presently a major research theme at my university – factors which involve not only that societal systems of regulation are marked by formal efficiency, transparency, clarity and so on, but also by them being trusted to a high degree by the general population. All of these factors, in turn, point to a further one: the inclusiveness, recognition and equal treatment of a society as regards the various social groups found in it, at the same time as individuals are not as a rule treated primarily as representatives of such groups. The latter is added in order to make clear that I am not here alluding to some sort of mindless "anything-goes-as-long-as-it's-part-of-your-culture" relativism.

General prevention strategies to reduce crime that work with factors such as these become more important to consider the more a society contains people who live their lives in severe circumstances, the wider the inequality of a society is, the more of corruption and legal insecurity is pestering the lives of citizens, and the more culturally pluralistic a society is. On a European level, where wide variation in all these respects is to be found, it would thus seem that general crime prevention is, in fact, an important – if not central –part of a sound hate crime prevention policy.

2. Prevention of "Hate" or Bias Against Social Groups
The other rather obvious approach to shape a prevention strategy with respect to hate crime connects to the other defining component besides crime, the "hate" or "bias" component. If hate crimes are crimes linked to the perpetrator entertaining a biased or disparaging view against the victim in virtue of perceiving the latter as member of some social group, preventing such attitudes in the first place seems the thing to do, doesn't it? In order to become clear about what that may involve, and to what extent it should be seen as a desirable or important part of a hate crime prevention policy, we need to make some qualifications.

First, trying to prevent the appearance and occurrence of these sort of attitudes is not necessarily only about fighting antagonism or prejudice between different social groups. Attitudes of the sort in focus may very well occur within such groups – and may thus be expressed between individuals who are members of the same group. A simple example would be person A saying to person B: "you are not behaving as a member of group X should", when both are members of group X. There are a lot of examples of crimes seemingly being committed on grounds such as these, such as harassment of people who do not conform to some religious or moral rule of their culture, assaults or infringements to discourage or impede socialising or forming relationships with members of other social groups, and so on. Some of these instances may, of course, belong to the cluster of problems which hate crime policies are aimed to target, but it is not obvious that all of them do. When it comes to the attitudinal component, hate crime as a societal problem foremost connects to inter-group antagonism.

Second, we have to distinguish between two conceptually separate pieces of the attitude. One of the pieces is the attitude towards the group. The other piece is the tendency to judge individual people on the basis of that attitude due to their (perceived) group-membership. Both of these seem to be necessary in order for a hate crime to ensue. However, it would seem that a preventive strategy targeting one of these pieces of the attitude would have to be rather different than a strategy targeting the other piece. Moreover, it is far from obvious that it should be the business of society to try to influence the first piece of the attitude. Suppose for instance, that the disparaging attitude towards the group is based on certified presence within that group of some phenomenon towards which it is perfectly legitimate to hold a disparaging attitude. This could be a custom harming members of the group, a traditionally held worldview containing obvious falsehoods, or something else in that vein. While society may have good reasons to fight and prevent prejudice, this would not apply in such cases. The second piece of the attitude, seems much more apt as a target of societal action. For even if the attitude towards the group would be well-founded and legitimate, it is still a fundamental flaw to judge individuals, who may very well themselves be victims of the feature of the group that explains the dislike. Simply put, preventive policy as regards hate crime targeting the attitudinal component should focus primarily on the phenomenon of overgeneralisation occurring when people project collective patterns of behaviour on single individuals.

This line of reasoning may not look immediately acceptable to everyone. Why? it may be asked, shouldn't society care about antagonistic attitudes between groups as such? Didn't you just say above that this is what is problematic about the attitudinal aspect of hate crime from a societal point of view? Indeed I did, but what has now been added is the observation that this component is complex, and that not all parts of this complex appear to be equally important. For sure, if strongly antagonistic attitudes between different groups in society develop, this is something for society to care about. But the reason for why that is so mainly seems to connect to what may follow such a development. It is not a societal problem as such that people hold prejudiced or biased views about each other. In fact, in a liberal democracy, it would seem that one of the core values that we cherish is that we are allowed to hold whatever views about anything we want. Society has some interest, of course, to try to promote an educated and rational approach to the formation of such views (which is, partly, where action to prevent overgeneralisation and projection comes in). But we cannot escape that in the end, people will form their own opinions about each other, factually as well as morally. Society is also, of course, entitled to push this basic moral message – forming as it is the basic motivation for this society in the first place. However, as just observed, that would seem to entail primarily fighting the overgeneralisation and projection tendency, since that phenomenon runs directly contrary to basic ideas about the equal value and respect owed to each individual person. We all owe each other the courtesy of judging and assessing each other on the basis of individual features and merits - that is a basic cornerstone of a liberal democratic society, and it is indeed the business of society to promote such an attitude.

3. Prevention of the Tendency of Acting Out Prejudice and Bias
Now, if we look closely at the concept of hate crime we see that the most important feature of hate crimes is fact neither the crime nor the attitudinal component, but the conjunction of the two. In effect, I argued in my former posting that one of the most salient reasons for society to have a hate crime policy is not the presence of bias and prejudice, not the presence of crime, but the presence of behaviour where people act out prejudice and crime in the form of criminal acts. In effect, it would seem that the most apt target of a preventive strategy would be exactly that.

Such a strategy is basically about building and promoting a clear and widely embraced culture of tolerance. While we may dislike each other and hold prejudiced views about each other, there is a limit to what we are licensed to do on the basis of that. This limit is not special, it is the same limit that we are not allowed to cross for any other reason as well (such as purely selfish ones). Thus, it is defined by criminal law. However, as society becomes culturally and socially more pluralistic, instances of people stepping over these limits due to bias and/or prejudice based on group-membership becomes more and more important to address from a basic societal point of view. Again, liberal democratic ideology basically celebrates difference. Thus, it is only to be expected that intra-societal socio-cultural variation is increasing. The same effect is equally (if not more) expected when several liberal democratic countries join up to form a union, like the EU. But even then, there is a limit to how much of difference is compatible with a decent society. We may think whatever we like about other people and groups, but we may not break the law because of such thoughts. This is the minimal portion of toleration that has to be in place for civilization to endure.

4. Preventing the Damage of Hate Crime
Now, quite obviously, preventing the aspect of hate crime mentioned in the former section comes down to the interest of society to prevent serious damage – in that case to basic building-blocks of a decent society. However, equally obvious, this is not the only damage done through hate crimes. Hate crimes do damage also by increasing the harm to crime victims (a view pursued foremost by Paul Iganski), but also by attacking the collective confidence and security of whole communities (as argued by, e.g. Barbara Perry). Moreover, we need to consider how patterns of hate crime may create negative spirals of self-reinforcing mechanisms. At a workshop in our project in Strasbourg in May this year, one of the several members of the European parliament that we spoke to pointed to how the acting out of bias and prejudice based on group membership against individuals of the targeted group can be expected to give rise to a similar outlook in the group to which the victim belongs towards the group to which the perpetrator belongs. This is a damage of sorts that connects closely to the aspect of hate crime addressed in the preceding section. We will meet both Barbara and Paul, in addition to a number of other scholars of the philosophy and theory of hate crime and related subjects, at a workshop in Gothenburg in just over a week from now, and I'm sure that more nuances and details on these aspects will appear in our discussions.

What is interesting to note, is that these damages may by themselves be targets of preventive policy. That is, even if hate crimes cannot always be prevented, the damage they do may be possible to at least mitigate. What I want to hold out here is that such prevention may come down to two rather different things. What is more, me and my German colleague in the project, Michael Fingerle, are hypothesising that, actually, some of these different approaches may be in severe latent conflict.

Roughly, we may distinguish, first, between preventive policies aiming for damage control and policies aiming for what in public health is known as primary prevention. Damage control is about going in when the damage is already under way and mitigate it is some manner. In the case of hate crime, an example of damage control would be if, for instance, society offers special counseling and support to hate crime victims. A primary prevention strategy, in contrast, works with the aim of having all potential victims (that is, virtually everyone belonging to a group at risk) prepared beforehand. We may also distinguish between applying such strategies at the individual or collective level. In the latter case, the strategy would work with not only the (potential) victim, but with the entire group, membership of which is what explains (potential) victimisation.

Michael likes to talk about these things in terms of resilience, a notion popular in social psychology and sociology. To be resilient is, basically, to be such that even when you are under strain, you hold up and is able to continue functioning in a good way. The idea, then, is to mitigate or prevent damage caused by hate crime by strengthening the resilience of individuals and/or groups. However, Michael has pointed out that this may mean very different things.

A classic idea about resilience of individuals or social groups is that they are equipped with psychological, cultural, social and other resources that help them stand up to external threats. However, in later decades a rather different approach to resilience has emerged, where the notion of coping has come into focus. This latter notion is markedly different from the classic resilience idea. To manage strains or external threats by coping is, basically, to give in and accept. Now, what has struck us when discussing this is that this latter strategy, at least in the hate crime case, would seem to go against the former one. If you respond to external strain in the form of hate crime by continuously accept the situation and adapt you may indeed succeed in mitigating some of the damage of the crime. However, in other respects you will actually add to this damage. In the individual case, maintaining resilience through coping can end up in the situation where you never leave your home due to the acceptance of the situation that you are a potential hate crime victim. In the case of entire groups, the coping strategy becomes quite ugly, meaning basically that oppressed people accept and adapt to the whims of the oppressor. In both cases, the end result seems to be that, first, hate crime does more damage than it would otherwise have done and, second, the chance of establishing a sort of resilience where individuals and groups are less prone to be damaged by hate crimes in the first place is considerably weakened.

Since the coping approach to resilience is currently very popular, this has given rise to some concern about what sort of preventive hate crime strategies are currently being deployed across the EU. Everything said above points to the importance of such policies being anything else than short-sighted.

Now, it is probably as obvious to anyone who reads this as to us in the project that the various aspects of hate crime that may be targeted by preventive policy connect to each other in various ways. One example is the last aspect discussed, where it is obvious that ideas about preventing or mitigating damage from hate crimes needs to be considered in the light of how the attitudinal aspect and the acting out aspect may be targeted. Another example is how the first aspect (general crime prevention), if successful, would seem to provide us with a situation where all of the other aspects become less problematic.

Tuesday, 13 September 2011

Swedish Government Apparently Doing a 180° Turn on Compensation for Victims of Foster Care Abuse

Well, well, I'm not surprised.... 

As previously reported, the Swedish government this weekend decided not to implement the recommendation by a governmental committee to economically compensate the victims of a deeply repugnant pattern of abuse and mistreatment within the national foster care system. And I was far from the only one reacting against this uncommonly ill-considered decision and the so obviously empty rhetoric with which it was presented. On the contrary, it would appear that ministers Maria Larsson and her colleagues in the government were the only ones in the country actually being in favor of the decision. The storm of criticism has been massive and coming from all angles, from grass-root voters of all political shades to important and influential national politicians of all parties besides the ones presently trying to run a minority government.

It's not very surprising, therefore, that the responsible minister yesterday (joined by the prime minister today) went public expressing her willingness to reconsider the decision. Larsson couldn't quite entirely face up to the fact that she and her mates had made a colossal political blunder – surrounding her statement with conditions about "the entire opposition" having to present an alternative proposal. But these are just empty words. Larsson and her boss Reinfeldt know very well that if they don't roll over, they will be humiliated by parliament and will have to go back to square one to do the job that parliament had decided to have them do in the first instance.

In comments in the Swedish media, representatives of the opposition either laugh off this childish behaviour, or express surprise at the so obviously politically stupid formulations by a responsible minister. So, as it looks right now, the compensation will be forthcoming, regardless of how much that hurts the pride of a minister who should indeed have known better in the first place.

Saturday, 10 September 2011

Goverment Decision not to Compensate Abused Swedish Foster Care Children: Hypocritical and Invalid

Early this year, a Swedish government committee revealed a scandalous rate of long-standing and severe abuse of children enrolled in the public foster care system (here, here, here, here, here, here). The deeply repugnant pattern of mistreatment goes way back in time, as far as the 1920's, and is, the committee reported, still ongoing. The committee recommended that the government, besides the obvious task of putting a halt to ongoing abuse and express an official apology to past victims, should offer substantial economic compensation to victims of abuses in the past.

Today, however, Sweden's current minister of children and the elderly, Maria Larsson (Christian Democrat), to big surprise reported that the government will not follow the recommendation of the committee (here, here, here, here, here, here, here, here, here, here, here, here)  The given reason is that a compensation scheme would be impossible to implement in a fair and legally secure way. This reason, however, appears to be completely invalid and, in addition, incoherent with established policy.

The suggestion to economically compensate victims of past abuse is consistent with the way that Sweden eventually came to handle victims of the compulsory sterilisation policies that were in operation between 1935 and 1975. These were offered economic compensation (besides an official apology) and this was swiftly implemented. So, obviously, it is possible to set up a satisfactory system for compensating victims of mistreatment resulting from official policy. Maria Larsson is simply not telling the truth here. Even worse: since she is well aware of the compensation in the sterilisation case, she is deliberately holding out a pretext as good reason.

To this may be added that the compulsory sterilisation program, when it ran, was part of officially condoned policy, enjoying broad support all across the political and religious board. It was also accepted as a part of acceptable professional practice by medical doctors. The decision to compensate thus was an ethical decision, based on the assessment that although no formal error had occurred, a serious moral mistake had been made. In the case of the abuse of foster children, however, it is obvious that formal errors have been made. Not least, official agencies responsible for the administration of the system have obviously committed serious errors of neglect. So, here we have something which is both a moral and a formal fault, but then the government decides not to compensate. This is official hypocrisy at the highest level.

And allow me to become a bit personal: Maria Larsson is supposed to represent a political party the stronghold of which is held out to be politics on the basis of christian ethics, with the interests of the weakest and most vulnerable at the center of attention. How she manages to look at herself in the mirror with a straight face when making the decision revealed today is beyond me: the hypocrisy apparently goes far beyond just inconsistent and ill-considered official policy making. This shakes the very fundamentals of our country's supposed "ethical" party.

But it doesn't stop there. At the same time as Maria Larsson deliver her deeply unethical, formally erroneous decision under the smokescreen of an obviously bogus reason, she has the extremely bad taste of offering the victims of the abuses for which Swedish public institutions are both morally and formally responsible a "ceremony" where an official apology is extended, to which the victims will be invited. In short: spit in their faces and make a ceremonial bow.
 Shame, shame shame!

Sunday, 4 September 2011

Abortion, Mental Health Problems and the Politicisation of Science

Just the other day, several UK newspapers (here, here) reported about a new, ambitious study on the relationship between abortion and mental health problems. Undertaken by Priscilla Coleman, professor at the Bowling Green State University, and published in the well-renowned journal, British Journal of Psychiatry, the study is a so-called meta-analysis where data and results from many different studies in this area are brought together and analysed as a whole. The result is that evidence speaks in favor of a significant statistical correlation between abortion and elevated risks of mental health problems after abortion. Not surprisingly, this news have been ceased on by political campaigners who want to push for more restrictive abortion legislation. Coleman herself is markedly more modest, concluding only that...

Consistent with the tenets of evidence-based medicine, this information should inform the delivery of abortion services.
In the news reporting, this statement has generally been read as a call for telling abortion seeking women about the risks. Now, if you believe in individual liberty, women's right to decide over their own body or is generally oriented towards pro-choice positions on abortion, this may not appear to be very shocking. After all, abortion is a serious medical or (when undertaken in later stages of pregnancy) surgical procedure that is often undertaken in the context of a personal crisis. If there indeed is a link between undergoing this procedure and suffering mental health problems, this should be explained to women contemplating abortion, shouldn't it? However, there are several question marks surrounding Coleman's result and what conclusions can be inferred from it, both scientifically and with regard to policy.

First, neither the news reporting, nor the abstract to the actual article reveals if and to what extent Coleman's analysis has controlled for relevant so-called confounders – i.e. other factors contributing to the onset of mental health problems. In particular, it is unclear to what extent the analysis has factored in the presence of mental health problems or risk factors for such problems before abortion and, indeed, pregnancy. When I had reason, several years back, to look at research in this area undertaken in Sweden, a repeated phenomenon was that there indeed were correlations between abortion and mental health problems, but that the occurrence of this problems almost always could be linked to the presence of such problems (or risk factors for them) before abortion or even the actual pregnancy. Now, Coleman's results indeed indicate that women who undergo abortion have elevated risks compared to a substantial control group. However, in lack of controlling for the presence of problems before abortion, this may just as well support the notion that women already suffering from mental health problems or who are victims of risk factors for this are more likely to establish pregnancies that they eventually would prefer to have terminated. Indeed, such a link was suggested by a large Danish study published last year in the highly ranked journal New England Journal of Medicine. This, in turn, may depend on a lot of different things, such as being placed in a dysfunctional psycho-social context (e.g. lack of a reliable partner, poverty, disorganised housing situation, et cetera). Hopefully, time will tell what quality Coleman's study actually possess in this respect and, in the case of deficiencies, that further studies are undertaken to investigate the issue.

However, even if it turns out that Coleman's results hold up to closer scrutiny, the sort of factors just mentioned make the interpretation of Coleman's practical recommendation made in the media quite odd, if not biased – just as the one reported about the reaction of many campaigners against liberal abortion legislation. For suppose that Coleman indeed is right in the strongest sense, is the most obvious conclusion then that we should move to restrict access to legal abortion? Actually not, since there is strong scientific support for the claim that such actions lead to no good (in particular, they do not prevent abortions). How about informing about the risk then? Well this looks more sensible, although, if the underlying explanation of abortion being a risk factor is that a certain portion of abortion seeking women are already burdened by mental health problems that threaten to become more serious if they are exposed to trauma of some kind, one may doubt the efficacy of such actions.

Instead, the practical conclusion that would seem to be gaining the most support would be this: Researchers like Coleman should rapidly proceed to develop instruments to identify those at risk, and abortion services should offer these women special post-abortion care and counseling, or even preventive actions before the procedure is undertaken that may serve to decrease the risk. If such an instrument proves difficult to develop, such care and counseling should become a standard ingredient of good clinical abortion practice all across the board. I must say that I find it a bit odd and worrying that Coleman's own practical suggestion does not focus on this. After all, if women's mental health is what you care about, practical implications should focus on actions directed at promoting that aim.