Does a paywall protect patient privacy?

A psychoanalyst has retracted an award-winning 2016 paper over concerns that it contained “sensitive” patient information.

On July 15, Judith L. Mitrani, a psychoanalyst based in California, published an article that included “sensitive clinical material” about a patient. Although we do not know what prompted the concerns, on November 21, Mitrani, in agreement with the journal’s editor-in-chief and publisher, retracted the article. The author and editor told us the retraction was meant to prevent non-experts from accessing the paper and to stop other non-Wiley sites from posting it.

The article was published after it had won the journal’s essay contest in 2015.

Here’s the retraction notice for “On Separating One from the Other: Images of a Developing Self,” published in the British Journal of Psychotherapy (BJP):

The above article, published in the British Journal of Psychotherapy online on the 15th July, and in print on 22nd July, 2016 on Wiley Online Library, has been withdrawn by agreement between the journal’s Editor-in-Chief, Ann Scott, and Wiley. This action has been agreed upon by the author, the editor and the publisher in response to their joint concern that certain sensitive clinical material regarding the patient discussed in the article may inadvertently result in the compromise of the patient’s privacy.

We reached out to Mitrani, who explained her decision to retract the article:

I retracted my paper from being posted on the internet as there seem to be many unauthorized sites and blogs, available to anyone that can put up a paper with detailed clinical material without permission of the parties involved and which allows material meant for education of colleagues only (i. E. Licensed mental health professionals) to be available for a fee to anyone. The issue of such fees which amount to the piracy of intellectual property is only second to the importance of preserving a patient’s privacy.

Many academic papers are available online to any reader (licensed mental health professional or not) for a fee — other articles in the same journal cost as little as $6 USD to read. This poses additional concerns, according to BJP editor-in-chief Ann Scott:

From my perspective as the BJP’s Editor, the situation with Dr Mitrani’s article has added another dimension to the existing debates about publishing clinical material in a digital age, and a fast-moving digital age. The unauthorized availability of her article for purchase on sites other than Wiley’s has brought the issue sharply into focus from an editorial perspective, in a way that had not been so clear before. Authors who submit sensitive material to the BJP (or other clinical journals) for what they anticipate will be a contribution to a professional debate may not be aware of the potential for a much wider dissemination of their work than they had expected. Resolving this worrying trend will need the concerted and collegial efforts of the entities and organizations that represent the interests of authors, clinicians, editors, publishers and copyright experts.

We asked Scott and Mitrani whether any specific incident sparked the privacy concern — were other non-Wiley sites posting the article and using the sensitive information inappropriately? Is there a way to avoid the privacy issues with a case study, even for an expert audience?

Mitrani declined to elaborate:

I have nothing to add to the statement below, which I believe is very comprehensive and does not further invade the privacy of anyone involved.

In 2015, Mitrani received a Rozsika Parker Prize from the BJP for the article, prior to its publication in 2016:

Ann Scott, Editor-in-Chief, BJP writes: We are delighted to announce the results in the Rozsika Parker Prize 2015 – the third year of the competition. The following authors have been successful:

…

Post-Qualification Path

Prize Winner Judith Mitrani, Training and Supervising Analyst at The Psychoanalytic Center of California, Fellow of the International Psycho-Analytical Association, Los Angeles: ‘On separating one from the other: images of a developing self’

The journal’s essay contest, started in 2013 in honor of British psychotherapist Rozsika Parker who had passed away in 2010, accepts essay submissions from clinical practitioners and students. According to BJP, winners and commended entrants will have their essay published in the journal, along with receiving other perks:

Prize-winning and Commended papers will be published in the Journal. A cash prize will be awarded to the Prize-winner in each category, along with a one-year online subscription to the British Journal of Psychotherapy  or the International Journal of Applied Psychoanalytic Studies.  Prize-winning papers will be presented at  a  BJP event, to be announced in due course.

The article has not yet been indexed by Clarivate Analytics’ Web of Science, formerly part of Thomson Reuters.

We’ve seen another case where access to information affected privacy concerns — last year, we covered a retraction where the family revoked permission to use their child’s photo after realizing the academic paper that published it was available open access.

Update 2/14/17 12:47 p.m. eastern: We’ve received the following statement from the publisher, Wiley:

Scholarly publishing in the digital age involves many contributors—research authors, clinicians, patients and publishers—working together to advance evidence.  Unfortunately, the digital age also brings about copyright issues with internet sites outside of the scholarly publishing area placing academic articles for public consumption. In addition to a violation of intellectual property rights, unlawful publishing of content in the public domain can sometimes compromise patient confidentiality as in this case.  Patient privacy has and always will be paramount in clinical medicine and Wiley along with our publishing partners at the British Psychotherapy Foundation proudly support this principle

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