A Further Plea for Caution Against Medical Professionals Overstating Video Game Violence Effects
2011; Elsevier BV; Volume: 86; Issue: 8 Linguagem: Inglês
10.4065/mcp.2011.0357
ISSN1942-5546
Autores Tópico(s)Stalking, Cyberstalking, and Harassment
ResumoIn reply: We thank Dr Murray and his colleagues and Dr Ferguson for their interest in our article. Debate in scientific literature is important for the field to advance and for all sides to be heard. One of the senior authors of our article, a law professor (T.D.), thinks it is important to remember that the First Amendment to the US Constitution, which was at issue in the case of Brown (formerly Schwarzenegger) v Entertainment Merchants Association, allows the medical profession and the population at large to engage in vigorous substantive debate.1Brown, Governor of California, et al, v Entertainment Merchants Association, et al. No. 08-1448. Argued November 2, 2010. Decided June 27, 2011.http://www.supremecourt.gov/opinions/10pdf/08-1448.pdfGoogle Scholar We think that the letter from Ferguson speaks for itself. In this reply, we focus on the letter from Murray et al entitled A Plea for Concern because they express more disagreement and concern with our article and its premise. Unfortunately, their letter enforces the points we made in our article that some in the scientific community are acting in an overly emotional, biased, academically dishonest, and ipse dixit (legal term for something asserted but not proved) “I am the expert” manner that hampers medicine's credibility and objectivity in our courts. As will be evident to individuals who read our article, Murray et al misrepresent, mischaracterize, and literally misquote our work. For example, the phrase “moral panic” does not appear in our article, but this did not stop the authors from putting it in quotes and directly stating that it did. In addition, they either intentionally or unintentionally confuse the points of our article, which focused on the specific issue of the effects that video games played in the Supreme Court case of Brown v Entertainment Merchants Association.1Brown, Governor of California, et al, v Entertainment Merchants Association, et al. No. 08-1448. Argued November 2, 2010. Decided June 27, 2011.http://www.supremecourt.gov/opinions/10pdf/08-1448.pdfGoogle Scholar Instead of looking at the issue before them, they focused on general media violence. Many of their references are from the 1970s and 1980s, a period before the violent video games in question were even developed. The situation of experts testifying about the effects of all media violence, instead of testifying specifically about violent video games, has been a frequent criticism of the courts concerning these cases, as we discussed in our article. Murray et al suggest that literature that should have been reviewed was not and that the works of specific organizations were summarily discounted for no reason. Contrary to their contention, a balanced review of the literature was presented, with specific sections in our article devoted to studies suggesting harm and studies not finding harm. The fair review of the literature in our article was not unlike Supreme Court Justice Breyer's dissenting opinion with attached appendix listing 115 studies “supporting the hypothesis that violent video games are harmful” and 35 studies “not supporting/rejecting the hypothesis that violent video games are harmful.”2Brown v Entertainment Merchants Association, 564 U.S. (2011) (Breyer, J. dissenting).Google Scholar What is alarming is that Murray et al not only misrepresent and discount our article in an academically unbalanced fashion but also dismiss and mischaracteriz the findings of the Supreme Court. They discuss Justice Breyer's dissenting opinion as “… he appended a listing of about 150 research and review articles to support his claim [video game violence being harmful].” The casual reader would not realize that about one-fourth of the 150 articles cited by Justice Breyer showed no harm, just as a casual reader would not realize that the studies cited in our article were in fact balanced pro and con. For those who have not read our article, it provided 48 references, which included a broad range of sources, including law reviews, court opinions, congressional testimony, and scientific articles. Many who have written articles understand that journals often have restrictions both as to the scope of a topic and the space available. Unfortunately, our article had to be reduced from its original size by about 2000 words and 30 references. Considering that books and thousands of articles over decades have been written on the general topic of media violence, it becomes a straw man argument to claim that the lack of inclusion of certain older works about general media violence is a flaw of our article. Works that find that video games do have a negative impact and the positions taken by professional organizations, such as the American Academy of Pediatrics, were cited and discussed, not simply rejected out of hand as Murray et al claim. In fact, there were no statements that either directly or indirectly criticized any professional organizations' stances on the issue of video game violence, again showing that Murray et al are engaging in an unfounded ad hominem attack on those with whom they disagree. In terms of familiarity with professional organizations, both of our article's physician authors (Ryan C.W.H., Richard C.W.H.) are members of the American Psychiatric Association (APA) and have served as delegates to the APA Assembly. We are very familiar with the process by which organizations approve policy and disagree with Murray et al that 170 American Psychological Association Assembly members voting on a position paper (unaware if unanimous vote of approval or not) written by 9 individuals is proof that a scientific issue is settled. There is a long history of organizations, such as the APA and the American Psychological Association, having an established position on a fact-based scientific issue that changed with time and the political environment. The classic case is that, before 1973, the APA defined homosexuality as a mental disorder and listed it as such in the Diagnostic and Statistical Manual of Mental Disorders, Second Edition, a widely accepted and used scientific document that was approved by the APA Board of Trustees and the APA Assembly at the time of its publication in 1968.3Homosexuality and sexual orientation disturbance: proposed change in DSM-II, 6th Printing, page 44 position statement (retired). Document Reference No APA. 730008.http://www.psychiatryonline.com/DSMPDF/DSM-II_Homosexuality_Revision.pdfGoogle Scholar The American Psychological Association held a similar position, which it did not change until 1975.4Fact and Information Sheet About: American Psychological Association Lesbian, Gay, and Bisexual Concerns Policy Statements.http://www.jmu.edu/safezone/wm_library/APA%20Policy%20Statements%20Fact%20Sheet.pdfGoogle Scholar Murray et al state that we suggested in our article that physicians should not talk to families about violence. This is another gross misrepresentation of our article. No matter why the blatant misrepresentation occurred, it serves only to inflame the tone and emotions of the debate and weaken the scientific credibility of our disciplines. Our article clearly dealt with physicians' interactions in the legal realm, not their clinical interactions. No recommendations were given, one way or the other, about what physicians should discuss with patients or their families. Obviously, if a physician is concerned that a particular child is affected negatively by a video game, as can occur with any stimulus (eg, drugs, negative peer influence, family dynamic, abuse), he or she should address that issue. We neither endorsed nor repudiated video games in our article; however, we did provide a historical context for the current debate by reviewing the 1950s comic book debate and testimony (which was referenced in the Supreme Court opinion), discussed the pros and cons found in the literature (also discussed in the Supreme Court opinion), and suggested points for physicians to be aware of when critically examining and reviewing the literature, such as whether studies showed correlation or direct causation (also referred to in the Supreme Court opinion). The overall tone of the letter by Murray et al, although not directly stated, was to remind physicians to approach testifying, whether before legislators or courts, “with opinions and testimony that are honest and as objective [eg, admitting limitations and plausible alternatives] as possible” as encouraged by The American Academy of Psychiatry and the Law, another organization to which 2 of us (R.C.W.H., R.C.W.H.) belong.5Mossman D Noffsinger SG Ash P et al.AAPL practice guideline for the forensic psychiatric evaluation of competence to stand trial.J Am Acad Psychiatry Law. 2007; 35: S3-S72PubMed Google Scholar 6American Academy of Psychiatry and the Law. Ethics guidelines for the practice of forensic psychiatry. Adopted May, 2005.http://www.aapl.org/ethics.htmGoogle Scholar Another accusation made by Murray et al is that we dismissed the work by Dr Anderson and Dr Huesman “as irrelevant or perhaps biased.” Both these individuals' works were cited and discussed. As part of the discussion, there were quotations and references to Anderson's work from other published articles and court opinions, which did suggest bias or ineffective testimony, such as. The research underlying Anderson's testimony, however, does not support such a stark and sweeping conclusion… [Defense experts] noted that Dr. Anderson not only had failed to cite any peer-reviewed studies that had shown a definitive [bold typeface added] causal link between violent video game play and aggression, but had also ignored research that reached conflicting conclusions.… They also cited studies concluding that in certain instances, there was a negative [italics added] relationship between violent video game play and aggressive thoughts and behavior (e.g., initial increases in aggression wore off if the individual was allowed to play violent video game for longer period). Dr. Anderson also has not provided evidence to show that the purported relationship between violent video game exposure and aggressive thoughts or behavior is any greater than with other types of media violence… or other factors that contribute to aggression, such as poverty. In fact, several of the studies he uses to support his conclusions examine media violence generally and do not disaggregate the effect of video game violence or compare the effects of video game violence to these or other forms of media violence.7Entertainment Software Association v Blagojevich, 404 F Supp 2d 1051 (ND Ill 2005).Google Scholar This excerpt comes from the judicial opinion of an earlier court case in which Anderson testified. It was very appropriate to include in our article because our article discussed how expert testimony has been perceived by the courts. It was also prophetic considering how the Supreme Court majority opinion (signed by 5 justices with 2 others agreeing with the holding but submitting differing concurring opinions, for a 7-2 decision) referred to Anderson's work and past testimony. The State's evidence is not compelling. California relies primarily on the research of Dr. Craig Anderson and a few other research psychologists whose studies purport to show a connection between exposure to violent video games and harmful effects on children. These studies have been rejected by every court to consider them, and with good reason. They do not prove that violent video games cause [bold typeface added] minors to act [italics added] aggressively (which would at least be a beginning). Instead, “[n]early all of the research is based on correlation, not evidence of causation, and most of the studies suffer from significant, admitted flaws in methodology [bold typeface added].” They show at best some correlation between exposure to violent entertainment and minuscule real-world effects,… In his testimony in a similar lawsuit, Dr. Anderson admitted that the “effect sizes” of children's exposure to violent video games are “about the same” as that produced by their exposure to violence on television. And he admits that the same [italics added] effects have been found when children watch cartoons starring Bugs Bunny or the Road Runner, or when they play video games like Sonic the Hedgehog that are rated “E” (appropriate for all ages), or even when they “vie[w] a picture of a gun.”1Brown, Governor of California, et al, v Entertainment Merchants Association, et al. No. 08-1448. Argued November 2, 2010. Decided June 27, 2011.http://www.supremecourt.gov/opinions/10pdf/08-1448.pdfGoogle Scholar It is also worth noting that Murray et al reference part of this opinion as well (eg, effects of video games being similar to those of television) but fail to mention that the Court found the science of many of the studies flawed. It is understandable why Murray et al did not acknowledge this finding by the majority of the Court, because it would make them look “foolish” (term used by Murray et al) when they “chastised” (another term used by Murray et al) us for suggesting that some have found “the evidence of harmful effects weak and confused.” The notion that our article used “old chestnuts” of discredited theory further highlights one of the many points of that report, which was that most of the arguments being brought to courts and legislators about violence and video games are theories that can change and are modified over time. We disagree that there is no validity to the catharsis theory. Along with learning theory, this theory was discussed in our article, with the catharsis theory being particularly discussed in the context of a 2010 study that found better mental health in individuals who played a moderate amount of video games compared with individuals who played extreme amounts or no video games.8Allahverdipour H Bazargan M Farhadinasab A et al.Correlates of video games playing among adolescents in an Islamic country?.BMC Public Health. 2010; 10: 286Crossref PubMed Scopus (62) Google Scholar The ipse dixit aspects of “trust us, we are the experts” are clear when Murray et al talk about their collective 200 years of experience, awards they have won, and discussion of positions they have held. We can make similar claims: We have won multiple major journal awards, have authored more than 400 publications, held national leadership positions in various organizations, served as delegates to the APA and American Medical Association, and collectively have 75 years of experience (considering there are just 3 of us, this is on par with their 200 years among 7 people). We also point out that the companion law review article to our article in Mayo Clinic Proceedings was chosen as one of the most influential law review articles in the field of entertainment law for 2010 by Reuters (for in-depth legal analysis and First Amendment concerns on this issue, such as legal differences between obscenity/nudity and violence, see this article).9Day TR Hall RCW Déjà vu: from comic books to video games: legislative reliance on “soft science” to protect against uncertain societal harm linked to violence v. the first amendment.Oregon Law Rev. 2010; 89: 415-504Google Scholar The use of the “we are the experts” argument is further highlighted by Murray et al when they reference a law review article that examines the qualifications of the experts involved in the amici curiae briefs. They spend time talking about who submitted the Gruel brief and the organizations that signed on to it, such as the California Psychological Association. However, they gloss over which authors contributed to the brief. Both the Gruel brief and the law review article were written in part by Anderson and Bushman.10Sacks DP, Bushman BJ, Anderson CA. Do violent video games harm children? Comparing the scientific amicus curiae “experts” in Schwarzenegger v. Entertainment Merchants Association. Northwestern University Law Review. 106 Nw. U. L. Rev. Colloquy 1 (2011).Google Scholar, 11Brief of Amicus curriae of Califorinia State Senator Leeland Y. Yee, PhD, The California Chapter of the American Academy of Pediatrics, and the California Psychological Association in support of Petitioners. Steven F. Gruel, Schwarzenegger v Entertainment Software Association No. 08-1448, July 19, 2010.http://www.americanbar.org/content/dam/aba/publishing/preview/publiced_preview_briefs_pdfs_09_10_08_1448_PetitionerAmCuLelandYee_AAP_CAandCAPsychAssn.authcheckdam.pdfGoogle Scholar It is not surprising that Anderson and Bushman found their own qualifications and the qualifications of the people who agree with them to be superior to the qualifications of the individuals who disagree with them. They came to this conclusion after reviewing the number of publications of individuals on the briefs by just searching the PsycINFO database, which is maintained by the American Psychological Association. This is important because, although none of us were involved in the amici briefs, if we were, we would have been overlooked because we are primarily published in medical journals such as Mayo Clinic Proceedings (not listed in PsycINFO database) and law reviews. Although it is sometimes important to know the accomplishments of authors, it is just as important not to blindly accept them as infallible. It is not the organizations to which authors belong, the number of years of experience they have, or the number of articles they have published that de facto defines the truth. In our article and again in this reply, we ask physicians to be “cautious” in how they present data and studies to legislators and courts, so as not to overrepresent their findings or implications for society. We caution them not to claim there is “no” disagreement, engage in ad hominem attacks, or mischaracterize the state of the field as being totally settled, when debate still exists. Engaging in a biased public policy crusade hurts all of medicine and the people we try to treat.
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