A few months ago, PLOS ONE published a study of parental reports on gender dysphoria in adolescents and young adults, which was the subject of strong criticism and debate shortly after publication (see example here or here). We also received a large volume of personal communication, which I have personally reviewed. I would like to thank everyone who took the time to contact us with their assessment of this study.

After this issue was brought to our attention, we conducted a formal review of the study and have made the decision to issue a Correction of the original article, as I will explain in this post. I would also like to apologise in particular to the trans and gender variant community for oversights that occurred during the original assessment of the study.

The post-publication review

PLOS ONE takes any valid concerns about published papers seriously and routinely looks into these, irrespective of who raises these concerns to us. As a journal, we have a duty, as part of our responsible stewardship of the scientific literature, to ensure the integrity of research that we publish. All valid research needs to stand up to scrutiny, before and after publication.

As part of our review we consulted with two Academic Editors, Dr Daniel Romer and Dr Angelo Brandelli Costa, as well as a statistics reviewer, and an academic who treats gender incongruence in adolescents.

In discussion with those parties we have reached the conclusion that the study and resultant data reported in the article represent a valid contribution to the scientific literature. However, we have also determined that the study, including its goals, methodology, and conclusions, were not adequately framed in the published version, and that these needed to be corrected. The changes include revisions of key sections such as title and abstract, which required us to republish the paper, allowing us to update the indexing of the article whilst preserving the original citation information.

The republication is accompanied by a Correction notice where the author of the study, Dr Littman, explains these revisions in more detail and provides further clarification regarding the study design and other concerns raised. To preserve the scientific record, the originally published paper is appended to the correction notice as a Supporting Information file. An accompanying Formal Comment by Dr Costa provides further context to the study, its aims, intentions, and its limitations. We are very grateful to Dr Romer and Dr Costa for their thoughtful consideration of the article and Dr Littman for constructively working with us to address the feedback.

As with all cases involving significant corrections to the published record, we have not taken this decision lightly, and do appreciate that there are different viewpoints about the study. In our view, the corrected article now provides a better context of the work, as a report of parental observations, but not a clinically validated phenomenon or a diagnostic guideline.

It is also clear, however, that the issues with this article could and should have been addressed during the original peer review process. In the name of the journal, I apologize for this oversight.

Whilst I do not make any excuses for the process prior to publication in this particular case, we also need to acknowledge that peer review prior to publication can never be a perfect safeguard. Post-publication review is not an unusual process, nor should such a process reflect negatively on those willing to correct honest errors and mistakes. As in this case, published articles may warrant further scrutiny to clarify whether the conclusions presented are indeed backed up by the analysis and data of that original study. Correcting the scientific record in this manner and in such circumstances is a sign of responsible publishing.

An apology to the trans and gender variant community

This case has also demonstrated the scrutiny scientific research can attract beyond the immediate academic community. As an Open Access journal, the research that we publish is accessible to everyone, and so far the study has been accessed by more than 140,000 readers. However, with such openness also comes the responsibility to ensure a rigorous reporting of research, presented with the necessary context. In this case, as a journal we have failed in this responsibility when reviewing and publishing the original article.

As Editor-in-Chief of PLOS ONE, I fully and sincerely apologize to the trans and gender variant community and others affected by those shortcomings. We should have handled this better. PLOS is an inclusive, open and non-discriminatory publisher that deeply cares for the concerns of this community. We should have taken the interests and the often difficult situation of adolescents experiencing gender incongruence into account when handling this manuscript for publication. We should have provided a better context of this research, its framing, and its limitations related to the study design. With the article’s republication, we address this by providing additional viewpoints and context via Dr Costa’s Formal Comment and Dr Littman’s Correction notice.

Going forward

As a journal, we are also responding to the lessons that we have learned, and we continue to learn from this case. We are in the process of strengthening the relations with the various research communities that we serve. When this study was submitted we had already had begun a restructure of our internal editorial team by subject areas to facilitate a better interaction with individual communities. This process has now been completed and we expect that going forward we will be able to better support our Editorial Board with matching expertise of staff editors. We are also in the process of reaching out further to the different research communities, in order to be able to provide a better service to authors, editors and readers alike. And last but certainly not least, we also aim to be more sensitive to studies of vulnerable populations.

We do acknowledge that the discussion around gender incongruence and results presented in this study will continue. We welcome this dialogue, and the need for further, inclusive follow-up studies on the topic. Research studies seen in isolation rarely provide a conclusive resolution of a research question, and it is only in the broader context of an entire body of literature that a complex research topic can be understood. In publishing the revised article, the Correction notice, and the accompanying Formal Comment, we do hope that the individual merits as well as conceptual limitations of this study can be appreciated in the appropriate context. Open scrutiny and discussion of academic research is an essential part of the scientific process, and we remain fully committed to supporting this public dialogue.