International Society for Traumatic Stress Studies

Correcting the Record about the Role of Science and Controversy in Public Policy

Posted 1 October 2006 in StressPoints by Dean G. Kilpatrick, PhD President, ISTSS

In a recent article in Science, my colleague, Richard McNally (2006), mischaracterized my position about the role of science in public policy concerning traumatic stress issues. McNally cited a column I wrote in Traumatic StressPoints (Kilpatrick, 2006) in the context of a commentary on an excellent article by Dohrenwend and colleagues (Dohrenwend et al., 2006). In his commentary, McNally said, “Indeed the president of the International Society for Traumatic Stress Studies recently urged critics to muffle their dissent, lest the intensity of scientific controversy distract us from attending to the needs of trauma victims.”

It is an honor to be cited in such a prestigious publication even if the citation is inaccurate, misleading and a complete mischaracterization of what I actually said. Also, anyone who knows me or who read the column in question understands that McNally’s citation does not reflect what I think or what I actually said. However, it is important to correct the record because McNally got things so wrong.

The column in question was titled “Our Common Bonds,” and I did not argue that controversy in the traumatic stress field is bad. In fact, I specifically stated that “research and treatment ideas benefit from being subjected to the crucible of criticism via the scientific method” (Kilpatrick, 2006, p.2). How anyone could interpret that statement or anything else in my column as advocating the stifling of scientific dissent is a mystery to me. My column primarily argued that we should attempt to disagree without being disagreeable or engaging in personal attacks, and that we should focus more on what we have in common than on our differences.

My final editorial in the Journal of Traumatic Stress provides a more developed expression of my perspective (Kilpatrick, 2005). In it, I noted that researchers who address controversial topics with public policy implications have a special duty to be accurate and responsible. This is important because scientists who report or cite research findings selectively, inaccurately or misleadingly do a disservice to the public policy process. Even the best science is of little value if results are mischaracterized, reported inaccurately or reported selectively to create a misleading impression.

Unfortunately, McNally’s article (2006) contains numerous inaccuracies and selective reporting of findings. I believe it does a poor job of describing what Dohrenwend and colleagues (2006) actually found, how well previous National Vietnam Veteran Readjustment Study (NVVRS; Kulka et al., 1990) findings were replicated, and the extent to which the new analyses failed to support prior criticisms of the NVVRS.

McNally focused primarily on the fact that Dohrenwend and colleagues found a reduction in PTSD prevalence when they used extremely conservative criteria, including using a subset of the sample that was assessed with a structured clinical interview, excluding cases with PTSD onset prior to military service, excluding cases whose war zone stressors could not be independently verified, and excluding cases that did not produce functional impairment (a PTSD criterion that did not exist in DSM-III R when the NVVRS was conducted). Whereas McNally described this as Dohrenwend et al’s most newsworthy finding, I think it is more blatantly obvious than newsworthy.

The NVVRS remains important almost 20 years after it was conducted. Numerous critics, including Burkett and Whitely (1998), McNally (2003), Satel (2004), and Wessley (2005), have argued that the NVVRS got it wrong about several things, not the least of which were its estimates of war-related PTSD. In my view, the NVVRS was exceptionally methodologically sound, and its findings are as relevant for veterans of today’s wars as for Vietnam veterans. I also think that the article by Dohrenwend and colleagues (2006) confirmed key findings of the NVVRS and refuted most objections raised by NVVRS critics. I doubt that McNally agrees with my assessment, although I do not question his commitment to veterans.

Make up your own mind about this particular scientific controversy. Read the Dohrenwend et al article (2006), McNally’s commentary (2006), and my column (2006). Better yet, come to the 2006 ISTSS Conference in Hollywood, Calif., in November and attend a featured symposium addressing this controversy. The symposium, “Controversies Surrounding the Psychological Risks of Vietnam for U.S. Veterans: Multiple Perspectives on New Evidence” will include presentations by Dohrenwend and McNally as well as by Richard Kulka and Bill Schlenger, members of the team that designed and conducted the NVVRS. I will participate, as will Terry Keane who will discuss implications for today’s veterans.

The symposium should be lively, informative, and perhaps even controversial. At ISTSS, we do not shrink from controversy, particularly if the controversy is about research that has the potential to improve services for victims of traumatic stress. We do, however, insist on accuracy, a balanced perspective and getting things right.

References

Burkett, B.G., & Whitley, G.  (Eds.). (1998).  Stolen Valor.  Dallas, TX:  Verity Press.

Dohrenwend, B.P., Turner, J.B., Turse, N.A., Adams, B.G., Koenen, K. and Marshall, R. (2006). The Psychological Risks of Vietnam for U.S. Veterans:  A revisit with new data and methods. Science, 18(313), p. 979-982.

Kilpatrick, D.G.  (2005). Final Editorial.  Journal of Traumatic Stress, 18, p. 589-593.

Kilpatrick, D.G. (2006).  Our Common Bonds. Traumatic StressPoints, Vol. 20, No. 2, p. 2.

Kulka, R.A., Schlenger, W.E., Fairbank, J.A., Hough, R.L., Jordan, B.K., Marmar, C.R.,  et al. (1990b).     Trauma and the Vietnam War Generation:  Report of findings from the National Vietnam Veterans Readjustment Study.  New York:  Brunner/Mazel.

McNally, R. J. (2003).  Progress and controversy in the study of Posttraumatic Stress Disorder.  Annual Review of Psychology, 54, p. 229-252.

McNally, R.J. (2006). Psychiatric casualties of war. Science, 313 p. 923-924.

Satel, S.  “Returning from Iraq, still fighting Vietnam,” The New York Times, 5 March 2004, p. A23.

Wessley, S.  (2005).  War Stories:  Invited commentary on documented combat exposure of US veterans seeking treatment for combat-related post-traumatic stress disorder.  British Journal of Psychiatry, 186, p. 473-475.