In Defence of Pseudonyms in Science: Defending the Right to Write

In Defence of Pseudonyms in Science: Defending the Right to Write

Fellow pseudonymous neuroblogger Neuroskeptic (to whom I owe a great deal in inspiration) has published a fantastic piece in Trends in Cognitive Sciences ($) on the benefits to science of anonymity. Last November Neuroskeptic became the first blogger to publish a scientific paper under a pseudonym. Neuroskeptic cites examples ranging from "Nicolaus Copernicus who first put forward his theory of heliocentrism anonymously, in the form of a manuscript now known as the Commentariolus" to the famous "Student" - creator of the t-test, whose real name was William Sealy Gosset. A list of scientists and mathematicians who have published under pseudonyms can be found here, which includes: Isaac Newton as Jehovah Sanctus Unus, Felix Hausdorff as Paul Mongré and Sophie Germain as Monsieur Antoine Auguste Le Blanc. The last is an example of a woman writing as a man in order to be taken seriously by mathematicians. Neuroskeptic gives the example of:


"The pioneering computer scientist Donald Knuth once submitted a paper under the name ‘Ursula N. Owens’. Knuth did this because, he said, he wanted to ensure that the manuscript received a thorough critique."

Neuroskeptic goes on to examine the case of Science-Fraud.org which was a fantastic anonymous resource focusing on data falsification and manipulation until it was closed following legal action which revealed the identity of the creator of the resource - biologist Paul Brookes. Neuroskeptic points out:

"Not long after the closure of Science Fraud, however, a paper by the first scientist to send Brookes a cease-and-desist letter, Rui Curi, was retracted. Another was corrected – to address just those image irregularities originally noted by Brookes"

Neuroskeptic makes the very important point that:

"By exposing misconduct, Brookes, and other investigators like him, do science a great service. Though anonymous, they contribute more to the advancement of knowledge than those who publish false data under their own names."

Neuroskeptic's paper couldn't come at a more opportune time, in only thirteen days new rules will come in to effect banning British doctors from using social media without their real names. We are already beginning to see the departure of familiar faces. If you'd like to help stop this, please sign this Downing Street petition against the ban on doctors writing anonymously. If this fails doctors may have to resort to the Human Rights Act to protect their right to write, as Max Pemberton (a pseudonym) writes in the Telegraph:

"It seems to me that, by preventing doctors from speaking out anonymously, the move is also ripe for a legal challenge, as it would seemingly contradict Articles 8 and 10 of the Human Rights Act. These guarantee a right to private life and to freedom of expression, without interference by a public authority. While the GMC is responsible for doctors’ conduct in the workplace – and no one is disputing the importance of this role – doctors are still entitled to a private life and to freedom of expression, and the GMC – an unelected and unaccountable quango – has no business interfering in this area. It has overstepped its remit. This is not about patient confidentiality, which is already covered in detail in the guidelines in which all doctors are well versed. This is simply preventing doctors from being allowed to speak out anonymously or under a pseudonym."

Pemberton sums up the fundamental importance of this case fantastically so I'm going to finish this post with Pemberton's argument for why we must protect the right for doctors to communicate without providing their given name:

This unwelcome intrusion into doctors’ private behaviour is relevant to everyone. This country has a long and rich tradition of individuals writing about their profession from behind a veil of anonymity. Oscar Wilde wrote that “man is least himself when he talks in his own person. Give him a mask, and he will tell you the truth.” Soldiers, nurses, ambulance drivers, lawyers and even prostitutes have all written under pseudonyms to preserve – for a variety of reasons – their anonymity. Authors such as James Herriot, Theodore Dalrymple and Miss Read have become touchstones to contemporary writers and bloggers, who use their work as springboards for their stories and who often provide valuable insights into social, cultural and political issues.

It is particularly worrying that for doctors, the right to anonymity in social media is under attack. The public is served well by individuals who use the internet or print to anonymously discuss what is happening in the health service. By this I do not necessarily mean the serious cases of abuse or neglect exposed by whistleblowers (although that is relevant, too) but the day-to-day stories of life in the NHS that so often expose larger truths; and the candid thoughts of those on the coalface dealing with the fall-out of government policy.

I should here declare an interest. As is widely known, Max Pemberton is a pen name that I use for my journalism. I decided to use a nom de plume when I started this column 10 years ago because I wanted to write frankly about my experiences in the NHS and I knew that I would struggle to do this if I used my real name. Over time, my colleagues came to know of my other career as a journalist and now, in my personal life, more people – including my partner – call me Max than Alex, the name I practise under.

But I’m pleased that there is still a robust distinction between my clinical work and my media career. I want it to be clear to my patients that when they sit in front of me I am not a journalist, but their doctor. It also helps me maintain a distance between my two careers. While most of my patients are aware of my work in the media, they are grateful for the distinction. Yet I know for certain that I would never have written those first columns if the GMC’s guidance had been in place then. Writing anonymously helped me to be honest.

These regulations will have a far-reaching impact. Doctors are naturally cautious and I can now see a time when they will be reluctant to pen anonymous pieces for the press, for fear that they will be tracked down by those they annoy and referred to the GMC. If they want to write articles criticising the government or NHS management, they will be in the impossible position of either disclosing their name or writing anonymously, risking exposure. This is a chilling situation. At a crucial time in the history of the NHS, silencing doctors in this way means the public will no longer hear their views about what is happening.

If you agree, please sign the petition (update: UK citizens only).

Reference:

Neuroskeptic, . (2013). Anonymity in science Trends in Cognitive Sciences DOI: 10.1016/j.tics.2013.03.004

Update 09/04/2013: The General Medical Council have responded to the concerns with a post on their Facebook page which provides some clarification:

Jane O'Brien from the GMC's standards and ethics team on our new social media guidance.

On the 25  March 2013 we published new explanatory guidance on Doctor's use of social media (PDF) alongside the new edition of Good medical practice for all UK doctors.The response from the  profession has been lively — particularly about the phrase:

'If you identify yourself as a doctor in publicly accessible  social media, you should also identify yourself by name.'

Like all our  guidance, Doctors' use of social media describes good practice, not minimum standards.  It's not a set of rules.

But the response from the profession shows that doctors are unclear or uncertain about:

  • Why  we included this in the guidance
  • What  'identify yourself as a doctor' means in practice
  • Whether  this curtails doctors' rights to express their views
  • Whether  the GMC would take disciplinary action against a doctor because they used a  pseudonym
  • Why  doctors shouldn't raise concerns anonymously
  • We’ve answered these questions below and also provided some background information about how the guidance was developed.

    Why identifying yourself as a doctor is good practice?

    Patients and  the public generally respect doctors and trust their views — particularly about  health and healthcare. Identifying yourself as a member of the profession gives  credibility and weight to your views. Doctors are accountable for their actions  and decisions in other aspects of their professional lives - and their behaviour must not undermine public trust in the profession. So we think  doctors who want to express views, as doctors, should say who they are.
     What does 'identifying yourself as a  doctor' mean in practice?
     There is a bit of judgement involved here. For  example, if you want to blog about football and incidentally mention that  you're a doctor, there is no need to identify yourself if you don't want to.If  you're using social media to comment on health or healthcare issues, we think it's  good practice to say who you are.In the guidance we say 'you should' rather than 'you must'. We use this language to  support doctors exercising their professional judgement. This means we think it  is good practice but not that it is mandatory.We've  explained the difference in our use of these terms in paragraph 5 of Good medical practice, and at:
     http://www.gmc-uk.org/guidance/good_medical_practice/how_gmp_applies_to_you.asp
    Does this restrict doctors' freedom  of expression?
     We are not  restricting doctors' right to express their views and opinions except:
  • Where  this would breach patient confidentiality 
  • Where  comments bully, harass or make malicious comments about colleagues on line. (A  colleague is anyone a doctor works with, whether or not they are also doctors).
  • One of the  key messages in the guidance is that although social media changes the means of  communication, the standards expected of doctors do not change when  communicating on social media rather than face to face or through other  traditional media (see paragraph 5 of the social media guidance). 
    Will the  GMC take disciplinary action if I decide not to identify myself online?
     This is  guidance on what we consider to be good practice. Failure to identify yourself  online in and of itself will not raise a question about your fitness to  practise.Any concern  raised is judged on its own merits and the particular circumstances of the case.  But a decision to be anonymous could be considered together with other more  serious factors, such as bullying or harassing colleagues, or breaching  confidentiality (or both) or breaking the law. The guidance doesn't change the  threshold for investigating concerns about a doctor's fitness to practise. 
    Does this guidance apply to personal use?The GMC has no interest in doctors' use of social media in their personal lives —  Tweets, blogs, Facebook pages etc. But doctors mustn’t undermine public trust  in the profession. Usually this means breaking the law, even where the  conviction is unrelated to their professional life. For an example, read the recent Fitness to Practise Panel decision on the MPTS web page (PDF).
    Why can't  I raise concerns anonymously in social media? We are not trying to restrict discussion about important issues relating  to patient safety and certainly don't want to discourage doctors from raising  concerns.However, we wouldn't encourage doctors to do so via social media because  ultimately it's not private and it might well be missed by the people or organisations who are able to take action to protect patients.Our confidential helpline — where you can speak to  an advisor anonymously — enables doctors to seek advice on issues they may be dealing  with and to raise serious concerns about patient safety when they feel unable  to do this at local level. Our Confidential Helpline number is 0161 923 6399.
    If  you want to talk to an independent organisation, we work with Public Concern at  Work whose legal advisors are trained in managing whistleblowing calls. They  can support and direct doctors who wish to raise concerns.
    Why do publications like the BMJ  allow anonymous blogs/letters articles? Does the guidance mean they can't do  that anymore?BMJ is entirely  independent of the GMC, and it is a matter for them to decide what is  appropriate for their website. However the Committee on Publication Ethics  considered a case and published their conclusions at
    http://publicationethics.org/case/anonymity-versus-author-transparency
    Many blogs  are published without formal editorial or publisher control — although there  may be moderation on some sites. Using your name (or other identifying  information) provides some transparency and accountability.
    Background
    How did we consult on the guidance?We consulted  on the explanatory guidance in 2012 and wrote to all registered doctors via our publication GMC News in May 2012 asking them to tell us their thoughts on the  draft social media guidance. As part of this  public consultation, we received 80 responses from organisations and  individuals (with 49 of the individual respondents identifying themselves as  doctors). Specifically we asked whether it was reasonable for us to say that  doctors should usually identify themselves when using social media in a  professional capacity and 63% (49 respondents) agreed while 16 respondents  disagreed and 13 were unsure. 39 of those who responded commented on this  point.Some of the responses from doctors in the consultation included: 
    'Doctors should take ownership of  information given in a professional capacity as it is important that we are  accountable for our professional actions.'
    'Too often, people hide behind  usernames on internet and on social media — if you have something to say,  don't be a coward.'

    Patients groups also felt that being  open and honest when communicating online was important saying:

    'Doctors should also be conscious of the widespread access to much social media, e.g. Twitter, which could mean that their social media engagement could endanger public confidence in the profession.'

    Of course, some expressed the opposite view including:

    'A doctor should be able to state that they are a medical professional without having to publicise their personal data. For example, when commenting on an online article it may be relevant that the comments come from a doctor but it should not require full identity disclosure. Where a comment is formal and part of a professional role, it would be more reasonable to expect identity disclosure.'
    What does the final guidance say?
     So after  careful consideration of all the views and the arguments on both sides the  final guidance says:
    If you identify yourself as a doctor in publicly  accessible social media, you should also identify yourself by name. Any  material written by authors who represent themselves as doctors is likely to be  taken on trust and may reasonably be taken to represent the views of the  profession more widely.
    What's happened since we published?
     e-petition
    We  acknowledge the level and strength of feeling the petition represents. However,  there is nothing in the guidance that restricts doctors' freedom of speech  online or stops them from raising concerns. The guidance is a statement of good  practice, and the paragraph on anonymity in the guidance is framed as 'you should'; rather than 'you must'; to support doctors exercising their professional judgement.

     

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    These Roman Emperors were infamous for their debauchery and cruelty.

    Nero's Torches. A group of early Christian martyrs about to be burned alive during the reign of emperor Nero in 64 AD.

    1876. Painted by Henryk Siemiradzki.
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    • Roman Emperors were known for their excesses and violent behavior.
    • From Caligula to Elagabalus, the emperors exercised total power in the service of their often-strange desires.
    • Most of these emperors met violent ends themselves.

    We rightfully complain about many of our politicians and leaders today, but historically speaking, humanity has seen much worse. Arguably no set of rulers has been as debauched, ingenious in their cruelty, and prone to excess as the Roman Emperors.

    While this list is certainly not exhaustive, here are seven Roman rulers who were perhaps the worst of the worst in what was one of the largest empires that ever existed, lasting for over a thousand years.

    1. Caligula

    Officially known as Gaius (Gaius Caesar Augustus Germanicus), Caligula was the third Roman Emperor, ruling from 37 to 41 AD. He acquired the nickname "Caligula" (meaning "little [soldier's] boot") from his father's soldiers during a campaign.

    While recognized for some positive measures in the early days of his rule, he became famous throughout the ages as an absolutely insane emperor, who killed anyone when it pleased him, spent exorbitantly, was obsessed with perverse sex, and proclaimed himself to be a living god.

    Caligula gives his horse Incitatus a drink during a banquet. Credit: An engraving by Persichini from a drawing by Pinelli, from "The History of the Roman Emperors" from Augustus to Constantine, by Jean Baptiste Louis Crevier. 1836.

    Among his litany of misdeeds, according to the accounts of Caligula's contemporaries Philo of Alexandria and Seneca the Younger, he slept with whomever he wanted, brazenly taking other men's wives (even on their wedding nights) and publicly talking about it.

    He also had an insatiable blood thirst, killing for mere amusement. Once, as reports historian Suetonius, when the bridge across the sea at Puteoli was being blessed, he had a number of spectators who were there to inspect it thrown off into the water. When some tried to cling to the ships' rudders, Caligula had them dislodged with hooks and oars so they would drown. On another occasion, he got so bored that he had his guards throw a whole section of the audience into the arena during the intermission so they would be eaten by wild beasts. He also allegedly executed two consuls who forgot his birthday.

    Suetonius relayed further atrocities of the mad emperor's character, writing that Caligula "frequently had trials by torture held in his presence while he was eating or otherwise enjoying himself; and kept an expert headsman in readiness to decapitate the prisoners brought in from gaol." One particular form of torture associated with Caligula involved having people sawed in half.

    He caused mass starvation and purposefully wasted money and resources, like making his troops stage fake battles just for theater. If that wasn't enough, he turned his palace into a brothel and was accused of incest with his sisters, Agrippina the Younger, Drusilla, and Livilla, whom he also prostituted to other men. Perhaps most famously, he was planning to appoint his favorite horse Incitatus a consul and went as far as making the horse into a priest.

    In early 41 AD, Caligula was assassinated by a conspiracy of Praetorian Guard officers, senators, and other members of the court.

    2. Nero

    Fully named Nero Claudius Caesar, Nero ruled from 54 to 68 AD and was arguably an even worse madman than his uncle Caligula. He had his step-brother Britannicus killed, his wife Octavia executed, and his mother Agrippina stabbed and murdered. He personally kicked to death his lover Poppeaea while she was pregnant with his child — a horrific action the Roman historian Tacitus depicted as "a casual outburst of rage."

    He spent exorbitantly and built a 100-foot-tall bronze statue of himself called the Colossus Neronis.

    He is also remembered for being strangely obsessed with music. He sang and played the lyre, although it's not likely he really fiddled as Rome burned in what is a popular myth about this crazed tyrant. As misplaced retribution for the fire which burned down a sizable portion of Rome in the year 64, he executed scores of early Christians, some of them outfitted in animal skins and brutalized by dogs, with others burned at the stake.

    He died by suicide.

    Roman Emperor Nero in the burning ruins of Rome. July 64 AD.Credit: From an original painting by S.J. Ferris. (Photo by Kean Collection / Getty Images)

    3. Commodus

    Like some of his counterparts, Commodus (a.k.a. Lucius Aelius Aurelius Commodus) thought he was a god — in his case, a reincarnation of the Greek demigod Hercules. Ruling from 176 to 192 AD, he was also known for his debauched ways and strange stunts that seemed designed to affirm his divine status. Numerous statues around the empire showed him as Hercules, a warrior who fought both men and beasts. He fought hundreds of exotic animals in an arena like a gladiator, confusing and terrifying his subjects. Once, he killed 100 lions in a single day.

    Emperor Commodus (Joaquin Phoenix) questions the loyalty of his sister Lucilla (Connie Nielsen) In Dreamworks Pictures' and Universal Pictures' Oscar-winning drama "Gladiator," directed by Ridley Scott.Credit: Photo By Getty Images

    The burning desire to kill living creatures as a gladiator for the New Year's Day celebrations in 193 AD brought about his demise. After Commodus shot hundreds of animals with arrows and javelins every morning as part of the Plebeian Games leading up to New Year's, his fitness coach (aptly named Narcissus), choked the emperor to death in his bath.

    4. Elagabalus

    Officially named Marcus Aurelius Antoninus II, Elagabalus's nickname comes from his priesthood in the cult of the Syrian god Elagabal. Ruling as emperor from 218 to 222 AD, he was so devoted to the cult, which he tried to spread in Rome, that he had himself circumcised to prove his dedication. He further offended the religious sensitivities of his compatriots by essentially replacing the main Roman god Jupiter with Elagabal as the chief deity. In another nod to his convictions, he installed on Palatine Hill a cone-like fetish made of black stone as a symbol of the Syrian sun god Sol Invictus Elagabalus.

    His sexual proclivities were also not well received at the time. He was likely transgender (wearing makeup and wigs), had five marriages, and was quite open about his male lovers. According to the Roman historian (and the emperor's contemporary) Cassius Dio, Elagabalus prostituted himself in brothels and taverns and was one of the first historical figures on record to be looking for sex reassignment surgery.

    He was eventually murdered in 222 in an assassination plot engineered by his own grandmother Julia Maesa.

    5. Vitellius

    Emperor for just eight months, from April 19th to December 20th of the year 69 AD, Vitellius made some key administrative contributions to the empire but is ultimately remembered as a cruel glutton. He was described by Suetonius as overly fond of eating and drinking, to the point where he would eat at banquets four times a day while sending out the Roman navy to get him rare foods. He also had little social grace, inviting himself over to the houses of different noblemen to eat at their banquets, too.

    Vitellius dragged through the streets of Rome.Credit: Georges Rochegrosse. 1883.

    He was also quite vicious and reportedly either had his own mother starved to death or approved a poison with which she committed suicide.

    Vitellius was ultimately murdered in brutal fashion by supporters of the rival emperor Vespasian, who dragged him through Rome's streets, then likely beheaded him and threw his body into the Tiber river. "Yet I was once your emperor," were supposedly his last words, wrote historian Cassius Dio.

    6. Caracalla

    Marcus Aurelius Antoninus I ruled Rome from 211 to 217 AD on his own (while previously co-ruling with his father Septimius Severus from 198). "Caracalla"' was his nickname, referencing a hooded coat from Gaul that he brought into Roman fashion.

    He started off his rise to individual power by murdering his younger brother Geta, who was named co-heir by their father. Caracalla's bloodthirsty tyranny didn't stop there. He wiped out Geta's supporters and was known to execute any opponents to his or Roman rule. For instance, he slaughtered up to 20,000 citizens of Alexandria after a local theatrical satire dared to mock him.

    Geta Dying in His Mother's Arms.Credit: Jacques Pajou (1766-1828)

    One of the positive outcomes of his rule was the Edict of Caracalla, which gave Roman citizenship to all free men in the empire. He was also known for building gigantic baths.

    Like others on this list, Caracalla met a brutal end, being assassinated by army officers, including the Praetorian prefect Opellius Macrinus, who installed himself as the next emperor.

    7. Tiberius

    As the second emperor, Tiberius (ruling from 42 BC to 16 AD) is known for a number of accomplishments, especially his military exploits. He was one of the Roman Empire's most successful generals, conquering Pannonia, Dalmatia, Raetia, and parts of Germania.

    He was also remembered by his contemporaries as a rather sullen, perverse, and angry man. In the chapter on his life from The Lives of the Twelve Caesars by the historian Suetonius, Tiberius is said to have been disliked from an early age for his personality by even his family. Suetonius wrote that his mother Antonia often called him "an abortion of a man, that had been only begun, but never finished, by nature."

    "Orgy of the Times of Tiberius on Capri".Painting by Henryk Siemiradzki. 1881.

    Suetonius also paints a damning picture of Tiberius after he retreated from public life to the island of Capri. His years on the island would put Jeffrey Epstein to shame. A horrendous pedophile, Tiberius had a reputation for "depravities that one can hardly bear to tell or be told, let alone believe," Suetonius wrote, describing how "in Capri's woods and groves he arranged a number of nooks of venery where boys and girls got up as Pans and nymphs solicited outside bowers and grottoes: people openly called this 'the old goat's garden,' punning on the island's name."

    There's much, much more — far too salacious and, frankly, disgusting to repeat here. For the intrepid or morbidly curious reader, here's a link for more information.

    After he died, Tiberius was fittingly succeeded in emperorship by his grandnephew and adopted grandson Caligula.

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