by Cara Richman, Western Kentucky University
"...before I can live with other folks I've got to live with myself."
—Harper Lee, To Kill a Mockingbird
The densely frosted windshield of your car doesn't seem to care that you're terribly late for work. In a stroke of decluttering genius, you tossed that seldom used windshield scraper you got a few Christmases ago, and that now-ruined credit card from your wallet made for an ineffectual substitute. Wasn't there some unspoken meteorological contract of life in the South: you tolerate sweltering summers in exchange for mild, uneventful winters? You know what you should do: wait it out, let your aged car's window defrost at a frozen snail's pace. But after five minutes, your patience—unlike the ice—is growing thin. The car's window is slightly less frosty right above eye-level on the driver's side. If you crane your neck just so, you can mostly see through the remaining haze. What are the odds that—in the time it takes for the windshield to completely defrost—the lack of visibility will cause a wreck? Do you put the car in drive and press the gas, or does the "what if" make you hesitate? You're risking your own safety and the safety of others if this happens to be the one morning that reduced visibility causes an accident. When you weigh short-term gain and urgency against the seriousness of long-term consequences, just how much are you willing to compromise on the transparency of your windshield?
Of course, your professional and academic career as a speech-language pathologist isn't a car, but it, too, can cause harm when driven with a lack of competence and responsibility. For an illustration of the conflict that a well-intentioned clinician and researcher might feel between transparency and professional drive, consider the fictional plight of Julianna. Julianna completed her CFY under a supervisor who is a leader in exercise-based dysphagia rehabilitation. For some patients, her supervisor utilized a preferred system that provided neuromuscular electrical stimulation (NMES) in tandem with the performance of evidence-based exercise programs dictated by the individual patients' physiological impairments. Julianna's supervisor encouraged her to review the literature and draw her own conclusions about using NMES in dysphagia treatment. Julianna read several studies on the topic, both those that supported and refuted the efficacy of electrical stimulation. However, Julianna never located the high-level evidence that would have definitively convinced her either way (Carter & Humbert, 2012). She was certainly encouraged by seeing many of her supervisor's patients have positive outcomes using NMES, and ultimately decided that she supports its use as an adjunctive modality for select patients completing exercise-based dysphagia rehabilitation programs until more conclusive research comes to light.
Now, Julianna is in the fifth year of her career at a skilled nursing facility. She still believes in the clinical benefit of the same NMES system that she was trained in a few years ago. In fact, representatives from the company who manufacture the system recently came to her facility to train her colleagues in its use and were impressed with her knowledge and skill. Julianna feels she can use her expertise to contribute to the mounting debate surrounding the effectiveness of NMES. She enrolls as a clinician on the Clinicians and Researchers Collaborating (CLARC) platform and is contacted by an esteemed researcher who asks her to collaborate on a single-subject study examining the use of NMES with one of her patients and co-present the findings at an upcoming conference. They collaborate on the design of an ABA study, and the research begins after the team receives IRB approval. Julianna feels excited to contribute to the ongoing conversation in the field concerning this novel intervention. However, about two weeks into the B-phase of the study, she receives a call from the company that manufactures the NMES system she is using in her research. They offer her a position as a clinical consultant and brand ambassador. It would be an absolute dream job for Julianna, allowing her to travel the country and share her knowledge and skills with fellow SLPs.
Julianna knows that she will definitely be accepting the position, which will officially begin a few weeks before she presents her findings at the conference. As she opens her email to notify her collaborator of this potential conflict-of-interest, she hesitates. She imagines how her audience members might perceive her disclosure statement, which heralds her as a financial beneficiary of the very company whose devices she used in research. What if her collaborator wants to discontinue the research altogether in light of her new direct affiliation with the company? She doesn't feel it's fair that she must choose between preserving the perceived objectivity of her data—which reflects months of hard work—and her new position. Maybe the "ignorance is bliss" adage applies here? After all, she knows that she will remain objective throughout the collection and analysis of the data. So why give her collaborating partner or colleagues any reason to question her findings? She would feel more confident and comfortable during the conference if she just kept her new job hidden until afterward.
With this line of thinking, Julianna stands at serious risk of violating the ASHA Code of Ethics, the 2010 revision of which more explicitly addresses ethical issues in research and scholarship (ASHA, 2014, Introduction section, para. 2). Principal III, Rule B, stipulates, "Individuals shall avoid engaging in conflicts of interest whereby personal, financial, or other considerations have the potential to influence or compromise professional judgment and objectivity" (ASHA, 2016). Furthermore, by failing to make the appropriate disclosures, she is also at risk of violating Principal III, Rule G, which states, "Individuals shall not knowingly make false financial or nonfinancial statements and shall complete all materials honestly and without omission" (ASHA, 2016). These guidelines should strip away any notions Julianna has about proceeding with her research as though nothing has changed. Convenient though it may be, any short-term professional gain is dwarfed by the significance of presented or published research that can send ripples into the field, impacting dozens of other practitioners and—in turn—their patients. The enormity of responsibility to disclose any conflicts-of-interest in reporting research is distilled nicely by Horne and Minifie (2011), who state, "The integrity of the scientific record—its accuracy, completeness, and value—ultimately impacts the health and well-being of society" (p. S346). The Code is clear: Julianna's objectivity in conducting this thread of research may now be obscured, and she owes her colleagues the right to weigh her evidence alongside her disclosures and draw their own conclusions. Robbing them of that right through omission could result in unintended consequences, including potential complaints filed against her.
Julianna begins composing the email to her collaborator so they may move forward with the appropriate disclosures. Ultimately, her strong professional drive might have briefly tempted her to step on the gas without achieving full transparency, despite the unknown consequences that lay ahead. However, she knows she must also live with her own conscience, and the thought of such a professional transgression looming in her rearview mirror—blemishing the integrity of her promising career and creating road blocks for clinicians pursuing evidence-based interventions for their patients—is more than she can bear.
American Speech & Hearing Association. (2016). Code of ethics. [Ethics]. Retrieved from /Code-of-Ethics/.
American Speech-Language-Hearing Association. (2014). Ethics in research and scholarly activity. [Issues in ethics statements]. Retrieved from: /Practice/ethics/Ethics-in-Research-and-Scholarly-Activity/.
Carter, J. & Humbert, I. A. (2012). E-Stim for dysphagia: yes or no?. The ASHA Leader, 175(5), 12–15. doi:10.1044/leader.FTR2.17052012.12
Horner, J. & Minifie, F.D. (2011). Research Ethics III: Publication practices and authorship, conflicts of interest, and research misconduct. J Speech Lang Hear Res, 54(1), S346-S362. doi:10.1044/1092-4388(2010/09-0263).
Lee, H. (1960). To Kill a Mockingbird. New York, NY: Grand Central Publishing.