Upon request, NEJM added note to help Texas distance itself from Planned Parenthood article

The New England Journal of Medicine added a disclaimer to a recent article about the effects of funding cuts to Planned Parenthood, after a request from the Texas Health and Human Services Commission, saying it wanted to distance itself from the paper.

Since the paper was published in February, one author has stepped down from his position at HHSC after facing disciplinary action.

The article suggested that birth rates among a group of lower-income women increased after the state cut down on support for Planned Parenthood. It drew a significant amount of media attention — and concern from the HHSC, which asked the journal to add a disclaimer to the article soon after publication. The journal complied, but embargoed the announcement of the change until 5 p.m. eastern time today.

Here’s the disclaimer that NEJM added to the article:

The views expressed in this article are those of the authors and do not necessarily represent the views or policies of the Texas Health and Human Services Commission.

“Effect of Removal of Planned Parenthood from the Texas Women’s Health Program” was published online in early February, and has not yet been cited, according to Thomson Reuters Web of Science. It considered the effects when Texas barred Planned Parenthood clinics from using public funds to provide healthcare. It found a decline in the number of claims for long-acting contraception — such as implants, IUDs and injectables — and an increase in the rate of childbirth among women receiving Medicaid. The findings received extensive media coverage, such as by The Washington Post and The Los Angeles Times, and on CBS News, with headlines like: “After Planned Parenthood closures, poor women started having more babies.”

One of the co-authors has retired from his job in the fall-out of the article: According to the Associated Press, Richard L. Allgeyer stepped down from his position as director of research at the Texas HHSC this month after facing possible disciplinary action for working on the study during business hours.

The correction happened shortly after the paper was published, a spokesperson for NEJM told us:

This article was first published Online First on February 3. The statement was added to the online version of the article on February 24 in response to a request from one of the authors. The statement will appear as part of a correction notice in the March 31 print issue. It arrived too late for us to update the article itself in the March 3 print issue, which had already shipped to the printer. We do not require (or request) these sorts of disclaimers. We publish them only when authors provide them.

Interestingly, the NEJM‘s formal announcement of the change for today at 5 p.m.:

The article should have included a disclaimer footnote: “The views expressed in this article are those of the authors and do not necessarily represent the views or policies of the Texas Health and Human Services Commission.” The article is correct at NEJM.org.

We asked a spokesperson for NEJM why the correction note was under embargo since the new text has been online for over a month (readers of Embargo Watch, another project by Retraction Watch co-founder Ivan Oransky, take note). She told us:

This correction travelled as part of the 3/31 print issue. New content in this issue is embargoed. Because this is a formal correction notice it is considered new, and why it is embargoed. As I mentioned, we added the note to the online version of the article as soon as we could. This correction in print is the formal addendum to the article.

Last author Joseph Potter, who works at the University of Texas at Austin, told us he worked with NEJM to make the change — after he was prompted:

It was requested by way of a letter from the General Counsel of Texas HHSC addressed to me.  I, in turn, authorized the change by way of an email addressed to the Deputy Editor of the NEJM.

The letter from Texas HHSC to Potter makes the same request as a letter sent to Caren G. Solomon, a Deputy Editor at the NEJM, both forwarded to us by a spokesperson for the commission. It asks the journal to distance the HHSC from the paper, noting the role of Allgeyer and another co-author, Imelda M. Flores-Vazquez, employed by the commission:

The article does not reflect the views of the Commission. Although Drs. Allgeyer and Flores Vazquez undertook this work as Commission employees, the article was written and submitted for publication without the Commission’s knowledge, review, or approval. For this reason alone, the article should not be represented to be “from” the Commission.

Further, the Commission would not have endorsed the opinions or conclusions in the article even had it been afforded the opportunity to review them. The article presents an incomplete picture of women’s health services in Texas by ignoring the movement of clients to other state programs and focusing on only one contraceptive service. The article also includes incorrect statements concerning the birth rate and number of births in Texas.

I ask that the Journal immediately remove from the article all references to the Commission and include a disclaimer clarifying that any views expressed by Dr. Allgeyer or Dr. Flores-Vazquez are not shared by their employer. These changes are needed to ensure that readers do not mistake the opinions and conclusions in the article for determinations by the Commission. the state agency responsible for the coordination of health and human services, including women’s health services, in Texas.

The correction follows criticism from Texas senator Jane Nelson. A letter from the HHSC to Nelson notes her concerns, saying she believes the article is “misleading to the public.” The letter includes Nelson’s request for an explanation of state employees’ involvement, as well as data and methodology, noting that:

HHSC requires that any study or publication from HHSC be cleared through a publication clearance process. This clearance process was not even initiated in this case, much less approved by HHSC.

A spokesperson told the AP that Allgeyer, now retired:

broke policy by working on the study on taxpayer time. Other co-authors included one of Allgeyer’s subordinates at the health commission, University of Texas researchers and an Austin attorney who represented Planned Parenthood in lawsuits over being excluded from the program the study examined.

“He should have never been putting in time on this study during the normal business day, he was paid to perform state business,” [Bryan] Black said in an email.

Allgeyer’s salary was $115,750 in 2014. According to his LinkedIn profile, he has worked at the Texas Health and Human Services Commission since 2001. We have asked Black if co-author Flores-Vazquez is still in her position at the HHSC.

We were unable to find current contact information for Allgeyer.

Potter told us that no changes were made to the article beyond the addition of the statement. We asked if he agreed with the disclaimer, and he said:

I saw no problem with adding the standard caveat regarding views of the authors not being those of the agency.

We asked Potter to comment on the HHSC’s criticisms of the article:

Our paper makes no claim to represent a complete picture of women’s health services in Texas, but rather addresses the impact of the exclusion of Planned Parenthood from a specific fee-for-service program.  The question of whether the drop in the provision of implants, IUDs and injectables we observed in counties with Planned Parenthood affiliates could be the result of movement of users to other programs is discussed in the paper.  We argue that such a shift is highly unlikely given that the Texas Women’s Heath Program is the payer of first resort.  The second part of our paper involves an analysis of the experience of women who were users of injectable contraceptive users in counties with Planned Parenthood affiliates.

The reason for focusing on injectable users is spelled out in the paper:

“Unlike other forms of contraception, this method requires regular provider visits and has a relatively short span of contraceptive effectiveness (3 months). These features of the method allowed us to observe changes in the rate of childbirth within 18 months after the claim, which would not be possible with LARC methods (which last longer) or oral contraceptive pills (which may be dispensed for a single month or up to 12 months per claim).”

Finally, the paper makes no statements regarding the birth rate or the number of births in Texas.  The results regarding births that we report are restricted to deliveries by women enrolled in the fee-for-service program who were using injectable contraception prior to the exclusion.

Last year, Potter wrote an op-ed in the San Antonio Express-News arguing that defunding Planned Parenthood hurt Texas women and that the state:

serves as a guide to what might happen nationally if Congress pursues the defunding of Planned Parenthood.

Potter has noted to the Washington Post that the article cannot prove a link between the increase in births and the funding cuts, but that:

“You’ve got a very strong signal that there was an impact of [the Texas exclusion of Planned Parenthood],” Potter said.  “The thing about this study, it more or less contradicts the claim you can’t implement that policy at no cost, without hurting people.”

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