Writing papers and grants during the holidays: An informal international conversation

Whether and how academics should write papers and grants during the holidays is a complex issue. Any advice whether they should must be qualified by a huge “It depends.”

shit academicsI will be providing some advice about writing during the holidays in  articles on LinkedIn (Follow me on Linkedin). The articles will carry a warning label that I got from “Steal like an Artist”:

Some advice can be a vice. Feel free to take what you can use, and leave the rest. There are no rules.

To conduct an informal poll about academics writing during holidays, I posted a query in various places, including my own personal Facebook page and that of Reviewer 2 Must Be Stopped 

The results were fascinating. I expected there’d be some differences associated whether the end of the year holiday was just a matter of a couple days or the extended 3 to 5 weeks that  some academics get teach in liberal arts departments in the United States. I thought there would be huge cultural differences. I didn’t think enough about gender issues.

blackwoman-techI did not post the query in these public sites with the idea I would simply harvest the quotes and post them. But what I got was great and a bit challenging of me and my preconceived notions.

Here’s a selection of what I got, including some comments that I made.

My post on Facebook pages:

I’m curious about cross-cultural differences in expecting to get writing done over the holidays. Many American academics look forward to the break from classes and grading. But they may have trouble balancing getting writing done with family responsibilities attached the holidays. My sense is that some other cultures it is considered a sign of mental disorder to write during holidays, when you should be relaxing. Please share your thoughts.

From an American male:

I know at non-R1s [universities and colleges in place a premium on quality of teaching, not publications],where teaching loads are heavier, scholars may feel they have to use holidays and summer to do most of their writing. Me, I’ve got a couple little things I may have to work on a bit, but I’m definitely going to prioritize family, relaxation and hobbies. Definitely not doing full-time days of writing!

From a UK female:

female-scholar-writing-mathematics-fomula-7607816Yes, of course. These are expectations (often expressed directly, explicitly by ‘managers’ who say that being an academic means working during weekends) in some institutions in the UK. But what can be more important than family time during Christmas? Definitely not writing another insignificant (however important we think our fields are) research paper about an aspect of social sciences that has probably been over-researched. My sanity was saved by reading ‘Return to meaning’.

From a male

In our culture it would indeed be considered a sign of a disorder for a normal person to sit at a computer and work during holidays. But as I said, NORMAL person – so this may not apply to academics.

A couple of other males

I think what’s being got at there is that unlike our students, we don’t have a 3 week break at Christmas, and another at Easter, and 3 months in the summer. The original question is conflating those two things though, although probably has more to do with the actual holiday time of however many days you nominally take off for Christmas/New Year but spend working instead.


Who wants time to write during which we anyway procrastinate. Do the smart thing, wish for 4 amazing, fully written manuscripts that will be lauded by reviewers 1 through 5, get an expedited review and publication process, will be read my many, discussed and cited by even more and win a few awards. It’s Santa Claus we’re talking about, dear colleagues, let’s make our wishes count!

Which got these responses from females:

As a woman with a small child my daycare is closed for two weeks so really I have little choice, and really we need to not call it a break if we plan to work,

I work in France. The bschool is closed for 2 weeks in August and 1 over xmas. Absolutely nobody expects you to work during this time..

Rather typical is writing during free time in Poland. Many students and my colleagues academics are writing during holidays too.

My experience of UK universities is that many people work. It’s not required, but often it’s the only time you get enough uninterrupted time to write – and promotions are linked to outputs such as grants and publications – so often, we write at Christmas. I will be writing my book – but in a relaxed way, with breaks as well.

Same in France. No obligation, but if you don’t do it, you perish.

 You may be interested in my line of research. I looked at the effects of vacations on employee well-being. And I also investigated the influence of work-related activities and lack of mental detachment from work during holidays. This article gives an overview of my findings: . Hint: the Dutch may be right. Have a happy holiday 🙂

Really interesting article! Sweden was also a place where I realized that not everyone was as workaholic as the US. The summer houses! Wish I could have stayed after my post-doc

An American male in the UK

young-man-studying-with-laptop-computer-on-white-desk_1139-980I was able to keep my lab open during the month of August, when everything else was pretty much shut down. However, not so for Christmas. They practically turned the electricity off in the building over Christmas break. However it has been several years since then, and I suspect that the many business-oriented administrators who’ve been hired to boss UK academics around since then have determined that the lights are on and the fire burning under the butts of the lowly academics.

A female posted

Come all ye scientists, busy and exhausted. O come ye, O come ye, out of the lab

I’ll be writing pretty much non stop over break. I might take off Christmas Day. I am at a R1 in US, and I don’t have tenure yet. I could never take the whole break off.

A male

Anyone who writes during the holidays takes work too seriously. Unless it’s a grant. Always write the grant.

A female

Yes! First, in other places, Christmas is a multi-day holiday. In Germany, for example, the 24th, 25th, and 26th are public holidays. They’re so family-centered that you’re not even calling other people on the 25th. On the 26th, maybe. And in general there is no expectation that anything gets done “between the holidays” (between Christmas and New Year’s) either. Everyone needs some down time.


When I was an academic teaching at UC Berkeley, the winter holiday break was three weeks and so there was more of a dilemma of taking a complete break from writing. In US med schools I had a choice of how to distribute any of 5 weeks/yr in addition to the enforced shutdown of 5 days Christmas-New Years.


I am curious how some European academics make a firm distinction between writing as work vs other things as fun. For some Americans, writing is fun.The cannot understand depriving themselves of at least some writing during extended holidays.

 Which got this response from a female in Europe

Writing is the most fun part of my job. But that still means not spending time with family and friends. There is a life out there, you know

I responded:

I think it was BF Skinner who first observed that keeping writing fun depends on protecting other fun activities from being threatened by it. I don’t think it’s an either or situation. I know that some American academics say much briefer time for writing during the holidays and ensure that it doesn’t intrude on responsibilities to their families….This something to be said for writing at least a small amount every day and thinking about what you’re writing. That can be integrated with a healthy commitment to the family.

To which a female from Europe responded

But who cooks the meals?

The male whose quote began this thread

I will say, I have come to (without planning) adopt the mentality of doing a little bit of work each day (literally including Christmas, T-day, my birthday, etc.) Although we may be only talking an hour or two (so it’s not oppressive) there are parts of me that wish I hadn’t developed this mindset…it would be nice to be able to have some days where I did 0 work-related things without feeling some internal pressure.

European females

May I add gender here? Sitting down and writing seems a lot kore straightforward for folks who have no holiday prep, cooking, baking, shopping, visiting people etc obligations. From the 22nd on I’m busy just with family stuff.


Personally, I write a lot better after a weekend without work. Or after holidays. To each their own.


I would hope that women academics who have spouses are able to negotiate the spouses doing some of the holiday/family tasks.

Some European females

Hope springs eternal. And I hope that male academics are doing at least half of the unpaid housework and care work. If not, all this talk about writing is just an insidious expression of gender privilege.


Exactly. And they should be doing those tasks without ‘negotiating’.


My wonderful hubby does all the housework – no negotiation, it’s just how things work in our house. We’ve previously split 50/50 and done things in different ways. We just work out what works best in the current circs and get on with looking after each other!

Me (in hindsight, rather naively)

Wow! I would like to think that it is possible to start a conversation about writing during holidays without being accused of expressing gender privilege. I coach grant writing and teach scientific writing and increasingly most of my students are women…

A European females

It’s not about “expressing” gender privilege. These privileges (of class, gender, family status) are simply there. When we talk about writing and productivity and balancing things in abstract, we tacitly ignore that some of us have a lot more things to…See More

A male

Well work-life balance is one issue where changing current norms would be a win-win. It will help everyone whether they acknowledge gender privilege or not.

A female

It’s best not to get defensive about privilege. Women are telling you something important and I suggest trying to connect with other realities. Some of us are single parents or in other arrangements where the mere mention of writing over the holidays is something that is a bit sad because we lack choice. Thanks for listening.

A male

I think there is US privilege going on here too.

A female

I don’t think it is that, the fact is there is gender privilege and as a man one benefits from it regardless of how one thinks about it, and it is impossible to discuss this topic without gender issues coming up as the holidays are when children are home from school and at the same time academics are expected to write write write, an expectation from the days of the white male academic either single or with a housewife, that has continued despite changing realities…(and not everyone has a spouse or an academic spouse, my husband has a real job where breaks do not exist so the burden is placed on me to do daycare drop off, pick up, and care over the holidays)

Another  female

I am highly prolific with taking weekends off. Everyone what s/he thinks works best but I am very concerned about your advice to junior staff.


Some people find writing a satisfying activity which they freely choose over other activities. They become academics because it gives them protected time and resources. The routine of writing small amount every day is recommended to establish a momentum. It is not just the time spent in front of the computer, but what spontaneously occurs when one is away from the screen and absorbed in another activity. ..Some of us have found it is much more satisfying and efficient to write small amounts every day and then get into other activities than to chew up one’s life with unproductive and unpleasant binge writing.

A female

Seconding what James said. I do take some time off to be with family during the holidays. But eventually I start itching to get back to writing. I write not because I have to, but because I *want* to. It fulfills me and sustains me. I go crazy if I don’t find time to write.

Who then elaborated

“Because for some of us, books are as important as almost anything else on earth. What a miracle it is that out of the small, flat, rigid squares of paper unfolds world after world after world, worlds that sing to you, comfort and quiet you or excite you. Books help us understand who we are and how we are to behave. They show us what community and friendship mean; they show us how to live and die… My gratitude for good writing is unbounded; I’m grateful for it the way I’m grateful for the ocean.” – Anne Lamott, Bird by Bird.


Anne Lamott is a fun writer and a strong advocate of writing everyday and strugglng to get the zero draft just right but to let it flow.

She replied

Exactly! Butt in chair. Write, write, write. The best texts aren’t written but *re*-written.

Another female

Having grown up in Sweden and working in the US, I definitely see cross-cultural differences, with Swedes being much more pro vacation. My US colleagues often bemoan the fact that they have to work on grants and manuscripts on their “time off”, but they also know that it’s necessary for advancement. I think those differences at least partly due to differences in expectations from their universities. Personally, I’m somewhere in between and work on way too many holidays, but as a single mom, I decided early on that ignoring my family was neither feasible, nor would I want to miss time with my kids. So I tried to carve out time for both. #SleepWhatSleep

A female

There is a great deal of confounding of creative (Lamott, Hemingway, Wolff) and academic writing in this thread. I am an N of 1, but I write both and they are very, very different. The impulse to write fiction every day is a creative, alive one about gaining entry into fictive worlds and characters. Academic writing is formulaic and insisting on doing it “every” day (including holidays) seems like workaholism. I agree with academic writing every work day. But should every day be a work day for academics?

A male

Damn your US authoritarianism why assumes yours is the only correct way when in fact US models of intellectual life are aberrant, ethically wrong, and lacking in rigor.

A female

I suspect family and loved ones might often disagree about taking half an hour a day away from them. There are times when they want to know they have your attention 100%. It’s not just the time spent away from them, but the working out how to fit it around holiday activities. It takes your attention away from them…That’s my two pennyworth..


I can remember ordering four pennyworth or chips from the fish and chip shop when I was a child after Brownies. We had to have four pennies in our uniform pocket along with a piece of string and a safety pin in case of emergencies. The old public phone boxes used to cost four pence to use. We didn’t care about emergencies too much. We wanted chips!

An American male

I strongly support your statement. I start by having students write a paragraph per day with an underlined topic sentence. Once they get that down, I get them to go to 200 per day and to always read every text aloud. If they are writing articles, I tell them, 300 words or if overwriting to start at a different location every day to avoid the perfect beginning and poorly edited body/tail. If writing a book, I tell them 500 per day but say that that is impossible if they have not been writing 200 per day before then.

A female

I write in the morning and stop by noon. My measure is by the hour not by how many words. By noon I have enough time to spend with family and what I call recreational reading ( including Facebook). It works out well for me.

A female

I go by minimum number of words. At times, my extended family tried to stop me from working, out of some fear it was not good for me. They don’t realize how much I cherish writing. So, I would just get it done before everyone got up, or late at night!

The last male commentator again

Writing every day is as necessary as playing etudes is to a pianist. It keeps your vocabulary limber and teaches the subtleties of phrasing.

A female

I used to waste my holidays on work until I realized how abusive this is. Now, I make it an unquestionable rule to rest and do whatever I want. No matter what wisdom and skill you may think you gain if you work during holidays I will argue you are kidding yourself as in fact, the only thing you actually do is to punish yourself.


What if you wanted to write because you found it fun?? But what if you found writing relaxing? I am retired from academia and write for fun and activism. A brief period of writing is like my wife playing the piano is for her.

Coyne of the Realm’s open letter to the National Health and Research Medical Centre (NHMRC) of Australia

I received the  message below from Australia. I attempted a timely response to the National Health and Research Medical Centre (NHMRC) concerning their convening of an Advisory Committee to provide advice on research, funding and treatment of Myalgic Encephalomyelitis (ME) and Chronic Fatigue Syndrome (CFS). [Please don’t let this establish an expectation that I can respond to such requests in the future, but this time I did.]

If you have any time to write to the NHMRC at me_cfs@nhmrc.gov.au before Thursday  I’d appreciate it enormously. As you know, professionals hold much more sway with government than us patients.

kangaroo_600_600My assessment of the situation in Australia:

To put it bluntly:  Detection and diagnosis, as well as research and public policy concerning Myalgic Encephalomyelitis (ME) in Australia are a disaster. There is a high likelihood of the situation becoming worse.

The letter to NHMRC

To whom it may concern:

I understand that an Advisory Committee is being established to provide advice on research, funding and treatment of Myalgic Encephalomyelitis (ME) and Chronic Fatigue Syndrome (CFS). I am told that it will convene on December 7 and that you are open to input from the international scientific community. I hope these comments reach you in time or that you otherwise will consider them.

By way of introduction, I am a Professor Emeritus of Psychology in Psychiatry at the Perelman School of Medicine of the University Of Pennsylvania. I have had a visiting professorship in the School of Psychology at Australian National University. I regularly come to Australia. In the past, I have given keynote addresses at the Australian Behavioural and Cognitive Therapy Association in Sydney, presentations at the World Congress of Behavioral and Cognitive Therapies meeting in Melbourne, a keynote at the Australian Skeptics National Convention in Brisbane and numerous talks and workshops on critical thinking and science writing throughout Australia. I particularly enjoy presenting to Australian audiences, because I feel so free to speak directly with a candor that does not always go over well elsewhere. I write here in that spirit and with that candor.

I have no financial conflicts of interest to declare with respect to myalgic encephalomyelitis a.k.a. chronic fatigue syndrome in terms of receiving any financial support from anyone for my opinions.

To put it bluntly:  detection and diagnosis, as well as research and public policy concerning ME in Australia are a disaster and there is a high likelihood of the situation becoming worse.

Epidemiologic data suggest that Australian GPs employ loose criteria for detection and diagnosis, seemingly considering a serious medical condition as simply being a highly prevalent “chronic fatigue”. The risk is that substantial numbers of patients may be denied treatment for treatable medical and physical conditions, whether already diagnosed or not yet diagnosed. Accurate diagnosis of these conditions may be delayed. Much of the treatment research similarly employs loose criteria. The combined failure of some Australian treatment studies to exclude minor common mental problems, the reliance on subjective self-report outcomes and the unblinded designs would lead to even homeopathy appearing effective. Generalizations are being made from patients who do not have the cardinal symptom of postexertional malaise (PEM) to patients who do not participate in the trials, but who have PEM and are at risk risk of harm from receiving these treatments.  In the United States, with stricter diagnostic criteria have now been adopted, Australian treatment studies are not admissible evidence. I’m not at all suggesting blindly following the Americans, but I think their extensive documentation empirical evidence for this position should be considered in the own right. RACP Chronic Fatigue Syndrome Clinical Practice Guidelines have rightly been criticized by patient groups as leading to misdiagnosis, unrealistic expectations for psychological approaches to ME, and and for ignoring accumulating evidence of biological parameters to properly and strictly diagnosed ME.

A planned RCT of online continuing education for health professionals funded by the Mason foundation would likely ensure the bad guidelines potentially leading to ineffective treatment and harm to some patients are going to be more consistently applied.

Australia is convening an advisory committee concerning research, funding, and treatment at a time when the Americans have already begun such a reevaluation, the Dutch are about to, and the British have announced a reconsideration of NICE guidelines. It is important to achieve a balance of viewpoints in the makeup of that advisory committee in terms of general practitioners, consumer/patients/advocates, and researchers. The risk is that glaring problems in the status quo will be perpetuated and emerging research in re-evaluations will be ignored.

To understand how some of these issues can be dealt with, I recommend a summary of a meeting held at the UK House of Lords in September 2017 between Professor Mark Baker, Director of Guidelines, NICE, and, Mr P Boorman, Communications, NICE and patient representatives for a summary of some of the issues involved in assembling committees reevaluating guidelines on myalgic encephalomyelitis.

I’ve examined a recently updated list of the membership of the advisory committee. It’s laudable that there are representatives of advocacy groups are members. However, there should be some concern about such groups that stand out from other advocacy groups in supporting treatments the other groups consider potentially ineffective or harmful. Similarly, it is laudable that Professor Andrew Lloyd is among the members. However, he has passionately and emphatically spoken out in favor of cognitive behaviour therapy and graded exercise therapy, which, for good reason, are no longer recommended by the American Agency for Healthcare Quality Research or Center for Disease Control. I’m particularly concerned by statements attributed to Professor Lloyd in a recent letter from Professor Rodney Phillips, Dean of NSW Medicine. They are almost verbatim from what I get when I submit statements from a member of the Dutch Health Council to Google translator. Perhaps they are drawing on the same talking points. I would hope that the presence of Professor Lloyd would be balanced with the presence of academics from MCRI, the ANU and Melbourne University who hold decidedly different points of view.

I am a member of the Cochrane Collaboration. I shared in one of their Bill Silverman Prize awards for my alerting the collaboration to conflict of interest as a risk of bias. In raising issues about balancing competing interests on the advisory committee, I’m not suggesting financial conflicts of interest, but that clear, strongly held beliefs that might be resistant to contrary evidence.

Finally, my own non-financial declaration of interests: I requested data that the PACE trial investigators had promised would be available as a condition for publishing in PLOS One, the megajournal where I am an Academic Editor. I had thought there would be a timely response to a straightforward request. Two years later, the investigators continue to refuse produce the data, and the Journal has taken the extraordinary step of placing an Expression of Concern on their article, which many interpret as the first step before a retraction.

Similarly, I have raised issues and dueling blogs with David Tovey, a senior administrator at the Cochrane concerning financial conflict of interest and switched outcomes in Cochrane reviews of graded exercise therapy. I was very surprised and disappointed when Dr. Tovey refused my request for individual participant level (IPL) for independent-re-review of a systematic review and meta-analysis in which the PACE investigators were directly involved. These experiences leave me with seriously concerns about the validity of the PACE trial and the Cochrane reviews that depended on studies with similarly coordinated switching of outcomes. So, do take these intellectual and scientific commitments of mine into account, but also consider the need for balance in the membership in the advisory committee for similar intellectual and scientific commitments.

Thank you for your consideration and do not hesitate to contact me if I can be of further assistance.


James C Coyne, PhD


Confirmation bias in JAMA Psychiatry article concerning neighborhood-level variation in risk of psychosis

quick takesThis is one in a series of Quick Takes intended to show you when you can reasonably dismiss an article from further consideration based on inspecting its abstract alone. Once again we are dealing with hype and exaggeration in a JAMA Network Journal.

The abstract reports but ignores that most incidence rate ratios (IRRs) confidence intervals included 1.0, and overall results are weak.


A more suitable conclusion would be that “only weak and inconsistent evidence was fouind  for neighborhood-level variation in risk of developing psychosis in rural populations.” That finding is somewhat surprising and inconsistent with some past research, but should not be suppressed.

This article represents a good teaching example of confirmation bias, whereby weak findings are interpreted as consistent with the dominant view in the literature.

Take away messages

Don’t assume that because a finding is reported in the prestigious JAMA journals, it is credible.

Pay attention to the numbers in abstracts, particularly the confidence intervals and whether they exclude 1.0.

Ponder the question of whether this kind of confirmation bias was required for such weak findings to get published in a prestigious medical journal.

The article

Association of Environment With the Risk of Developing Psychotic Disorders in Rural Populations: Findings from the Social Epidemiology of Psychoses in East Anglia Study Lucy Richardson, MSc1; Yasir Hameed, MRCPsych2; Jesus Perez, PhD, MRCPsych3; et al

Excerpt from the abstract

Results  The study included 631 participants who met criteria for FEP and whose median age at first contact was 23.8 years (interquartile range, 19.6-27.6 years); 416 of 631 (65.9%) were male. Crude incidence of FEP was calculated as 31.2 per 100 000 person-years (95% CI, 28.9-33.7). Incidence varied significantly between neighborhoods after adjustment for age, sex, race/ethnicity, and socioeconomic status. For nonaffective psychoses, incidence was higher in neighborhoods that were more economically deprived (IRR, 1.13; 95% CI, 1.06-1.20) and socially isolated (IRR, 1.11; 95% CI, 1.04-1.19). It was lower in more racially/ethnically diverse neighborhoods (IRR, 0.94; 95% CI, 0.87-1.00). Higher intragroup racial/ethnic density (IRR, 0.97; 95% CI, 0.94-1.00) and lower intragroup racial/ethnic fragmentation (IRR, 0.98; 95% CI, 0.96-1.00) were associated with a reduced risk of affective psychosis.

These are trivial differences of which only two of five reach conventional significance, when one actually inspects the confidence intervals. Maybe the authors and editors are assuming that readers pay attention to such information or maybe they are hoping that readers accept the earlier statement: Incidence varied significantly between neighborhoods after adjustment for age, sex, race/ethnicity, and socioeconomic status.

The article ends with an attempt to explain the “finding”:

We found evidence of variation in the incidence of FEP across the rural-urban continuum, associated with deprivation, social isolation, and racial/ethnic composition. Social adversities, or failure to assuage the negative consequences of such adversities,40 may increase risk,39 but carefully designed longitudinal studies are required to determine causality.

What is an incidence rate ratio?

“Incidence rate ratio (IRR) – Incidence rate ratio is the ratio of two incidence rates. The incidence rate is defined as number of events divided by the person-time at risk. To calculate the IRR, the incidence rate among the exposed portion of the population, divided by the incidence rate in the unexposed portion of the population, gives a relative measure (IRR) of the effect of a given exposure and approximates the relative risk or the odds ratio if the occurrences are rare.”

Develop a life-threatening illness before tenure, lose your faculty position and your health-insurance

SUNY Buffalo

Another revealing story of just how  vulnerable Americans are with respect to health insurance and security of employment when they become ill.

The Dutch do it differently

I just came back from a series of lectures to occupational and insurance physicians  in the Netherlands

I was fascinating to learn from my casual conversations with the physicians about the role they played in an almost unimaginably different social system than what we have in the United States.

For a start, we  really don’t have widespread equivalent professional roles in the United States.

Suppose you take a job in the Netherlands and become ill. From the first day, your employer assumes responsibility not only for your health-insurance, but for returning you to whatever level of work you can do as soon as possible.

The employer is also responsible to pay you  while you are out sick for a considerable period of time. Unlike the United States, you don’t have to accumulate paid sick days ata rate of a day or two per month of employment. In the United States, also in contrast to the Netherlands, you may find that taking un paid sick days jeopardizes your job. Don’t even think about taking unpaid time off  for care of a sick relative.

If this is an inaccurate contrast, I welcome any of the occupational insurance physicians with whom I interacted to correct it, or anyone else. But the story below conveys a very different situation the United States for a faculty member on a tenure-track at SUNY Buffalo.

From Inside Higher Education. I encourage you to get a free subscription to their daily newsletter.

A Failed Race Against the Clock

A professor loses her job at SUNY Buffalo, and her advocates say she was denied not only a fair shot at keeping her position, but the ability to stay on health insurance while facing a life-threatening illness.

The basic story

What was a simple nonrenewal of a contract in 2016 has turned into a winding dispute, leaving the professor in question with a life-threatening illness and now — after failed back-channel negotiations between faculty members and administrators — no health-insurance support from SUNY Buffalo. The consequences are likely to go beyond the professor, as well, as faculty and union leaders lead a charge to prevent a similar situation from happening again.


Illness and Negotiations

During the time that the ad hoc grievance committee was investigating the professor’s dismissal, the professor developed a life-threatening illness, Glick said. And come Aug. 15, she would be removed from SUNY Buffalo’s health insurance.

Glick’s solution was to ask the provost to reappoint her temporarily and have faculty members donate their sick pay so she could continue to receive a paycheck and benefits for six months, with the thinking that she would then transition to state disability services.

The university, however, found that would constitute an illegal use of public funds. The union countered with a legal opinion that the arrangement could have been legal.

The back-and-forth, however, never amounted to any sort of agreement. The professor was let go in August as scheduled and lost her health insurance

I would be curious about reactions from academics in the Netherlands and other countries, as well as from my fellow Americans.

Do you like these brief commentaries with links to the social media where you can get more details?

I’m considering offering a service at CoyneoftheRealm.com after the first of the year that may interest  you or someone you know. I will filter out the bad, boring and misleading from social media and offer comments on great content I have carefully selected. These e-zines will be particularly suitable for people who either don’t have the time to search for themselves or who still consider involvement in social media a waste of time.

Stay tuned. Meanwhile, you might want to check other interesting developments at CoyneoftheRealm.com




No, seats on the US Institute of Medicine advisory committees are not for sale, despite what the Dutch Parliament was told

How the Executive Director of the Health and Medicine Division of the IoM responded to Professor Pim van Gool, the President of the Dutch Health Council disparaging the reputation of the IoM in testimony to the Dutch Parliament.

A likely reason for this unprofessional behavior is that van Gool was motivated to discredit the IoM’s stance on myalgic encephalomyelitis/chronic fatigue syndrome (MEcfs) because a recent document fron the IoM undermines the status quo concerning the illness in the Netherlands..

The incident speaks to the trustworthiness and commitment of the Dutch Health Council to best evidence in evaluating policies concerning MEcfs. Patients and their carers and advocates would do well to be vigilant for the next move from the Dutch Health Council.

The excerpt below is a translation of a transcript from a June 15, 2016 hearing before the Dutch Parliament. The President and Vice President of the Health Council of the Netherlands were appearing before Parliament to inform members about the installation of advisory committees concerning MEcfs.

Special thanks to Lou Corsius who provided the videotape, complete with English subtitles,  as well as the official response from the Institute of Medicine, which was a direct response to an inquiry from Lou.

The misrepresentation of the Institute of Medicine that occurred has immediate current relevance because of the likelihood that  Parliamentiary meetings will soon be held to reevaluate the official Dutch position on this illness.

Who’s who in the excerpt from the transcript

Pim van Gool: President of the Dutch Health Council

Henk Van Gerven: MP, Chairman of this meeting

Hans Severens: Vice President of the Dutch Health Council

Transcript [downloaded and edited from the subtitles provided by Lou Coursius

Starting at 6 minutes 54 seconds

Van Gool:  We received the request to advise in April 2015. At that time we had already been starting up because we knew this request would be submitted. We took explicitly notice of the IOM [Institute of Medicine] report in the US, dated February 2015.

Van Gerven: Can you explain IOM? Not everybody knows what that is.

Van Gool: Institute of Medicine. That is… we want to say that is a bit like the American Health Council. It is not exactly comparable. They  show a bit less scrutiny towards the interests of participants there. Amongst other things one can buy a chair to participate in the advisory process. That is an interesting business model but that is not the model we apply (Van Gool and Severens chuckle). Immediately in May & June one of our most experienced and respected scientific secretaries, dr De Neeling, has contacted 9 scientific associations, the general practitioners, the specialists in internal medicine, in physical rehabilitation, the neurologists, the association for behavioural therapy, the paediatricians, physicians in occupational medicine, etcetera, to actually ….as a hall stand (as a frame) we took that American report, more than 300 pages, very broad exploration, with also a very interesting new position that has been taken,  including a proposition to use another terminology for these issues (he does not use the word illness). We asked them to reflect on this IOM report as a start, actually.

Why did Pim van Gool misrepresent the Institute of Medicine?

 He and his fellow health council members were quite unhinged by the shift in the official American position concerning MEcfs in a report released by the IoM in February 2015. van Gool alludes to the report in the transcript excerpt suggests there is a mobilization of effort to undermine it.

Beyond Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Redefining an Illness

The full IoM report  is freely available here

A 4-page official briefing on the IoM report is available here.

The primary message of the committee’s report is that ME/CFS is a serious, chronic, complex, systemic disease that often can profoundly affect the lives of can profoundly affect the lives of patients.

IOM diagnostic.PNGImportantly, the IOM report provided new diagnostic criteria that made post-exertional malaise (PEM) a requirement for a diagnosis. It is a defining symptom:  no PEM means no diagnosis of MEcfs is warranted.


Dutch treatment studies employed looser criteria that did not require PEM. The IOM diagnostic criteria have subsequently been used by the US Agency for Healthcare Quality Research (AHQR) to reject the relevance of any research, notably Dutch research, that did not include PEM in the entry criteria. Furthermore, patients who are characterized by PEM are likely to be harmed by cognitive behavioral therapy and graded exercise therapy, which are considered frontline treatment in current Dutch guidelines. The US Center for Disease Control would subsequently removed CBT and GET from the list of recommended treatments.

To preserve their status quo, the Dutch Health Council must discredit the IOM report.

Lou Corsius alerted the IOM to Pim van Gool and obtained this response:

The official response from the Institute of Medicine

Director IOM: Official statements President Dutch Health Council incorrect

Van: Behney, Clyde <CBehney@nas.edu>

Verzonden: zondag 19 juni 2016 22:40

Aan: Lou Corsius

CC: Frakes, Chelsea

Onderwerp: RE: Questions about scrutiny IOM, claims posed by president of Health Council of the Netherlands

Dear Mr. Corsius,

Thank you for bringing this matter to our attention.  The National Academies of Sciences, Engineering, and Medicine (the Academies) stand behind the Institute of Medicine (IOM) report, which was prepared by experts in the subject matter and was subjected to our rigorous peer review process before it was released, as we do for each of our studies.

I can assure you that the only way one can become a member of the National Academy of Medicine (NAM, formerly IOM) is by being elected by the members of the National Academy of Medicine based on distinguished professional achievement in a field related to medicine and health. One must first be nominated by two members of the NAM who are required to document how a nominee meets the criteria for membership and then be subsequently elected by the full membership of the NAM.

One cannot buy a membership in the NAM, nor can one buy a role as a member of one of the committees that conduct studies and produce our reports. Additionally, all members, including the chairs, of our study committees undergo a very strict review for conflicts of interest prior to their appointment, and we also notify the public about the proposed members for each of our committees twenty days before the first committee meeting so that the public can identify any potential conflicts of interest before the committee begins its work.

Thank you again for making us aware of the statements.

Very best regards,


Clyde J. Behney

Executive Director

Health and Medicine Division

National Academies of Sciences,

Engineering, and Medicine



Probing the claim a black, working-class man would have to call 80 psychotherapists to get an appointment.

Study of returned calls from psychotherapists for requests for first appointments got lots of attention in social media but were claims accurate?

hands from da VinciA recent paper  reporting results of calls to psychotherapists for a first appointment got lots of attention in social media after a story in The Atlantic  made provocative statements about  its results.

Some of the claims in the Atlantic article resonated with readers assumptions about how difficult it is to get an appointment

Even for those with insurance, getting mental healthcare means fighting and through phone tag, payment confusion, and even outright discrimination

A lot of the attention to the Atlantic article was due to prominent display of the claim:

black man would

Sure, it is plausible that a black working-class man would have a harder time getting an appointment, but it really take 80 to get a first appointment?

The Atlantic article zeroed in the interaction between gender, class, and race that was presented as more complex in the actual report of the study

Among working-class callers, the study showed equal rates of appointment offers between white and black callers; if perceived race were causing class misidentification by therapists, then one would instead expect to see lower appointment offers for black working-class callers. If anything, the true race differences within the middle class may be slightly smaller than observed, and the class differences among blacks may be slightly larger than observed. Ultimately, the sizeable and statistically significant effects support the conclusion that there is a true disadvantage to black middle-class help seekers and all working-class help seekers, relative to middle-class whites.

So maybe class mattered more than race.

The apparent strength of findings might reflect methodological weaknesses of the study and the author’s stereotypes as much as the prejudices of the therapists who were called. The Atlantic article noted:

Heather Kugelmass, a doctoral student in sociology at Princeton University, selected 320 therapists from the directory of Empire Blue Cross Blue Shield’s HMO plan in New York City. She then had voice actors call them and leave voicemail messages saying they were depressed and anxious. They asked for a weekday evening appointment. She distinguished between different income groups by altering the vocabulary and grammar in the scripts, and she used studies on African-American vernacular and Black-accented English to craft the African-American callers’ scripts. The lower-income white callers spoke in a heavy, New York City accent. All of the callers mentioned they  had the insurance that the therapists purportedly accepted.

The Atlantic article acknowledged:

And it’s hard to purposefully make a person sound poor or black. In the working-class white script, for example, the actor said “hiya doc,” instead of “hello,” and mentioned “on the website I seen your name.” The working-class black script included flourishes that bordered on cartoonish, like “a’ight?” and “my numba.”

The Atlantic article drew some strong reactions, like from a psychologist from Australia, where there are different expectations of psychotherapists:

facebook shocked.

But a Minnesota psychiatrist offered a more sympathetic view of the therapists, noting that insurance companies and managed care share some of the responsibility for the difficulties those in need have in getting a first psychotherapy appointment.

only ways to keep doors open

Finally, the Atlantic article provided some relevant statistics

Between 30 and 50 percent of psychologists run their own practices, which allows them to largely control their own schedules, client rosters, and insurance networks. About 30 percent appear to accept no insurance at all, according to the American Psychological Association, a trade group for psychologists.


More than half of all counties in the U.S. have no practicing psychiatrists, psychologists, or social workers. In any given year, about one in five Americans has a mental illness, according to the National Alliance on Mental Illness, but nearly 60 percent of those people don’t get services.

And some good quotes, like:

“If it’s a market where you pretty much have to pay for yourself, the rich are always going to win,” Stanford University psychiatry professor Keith Humphreys told KQED recently

The original study reintroduced the concept of the YAVIS patient desired by therapists, something  I have discussed with respect to psychosocial care of cancer patients. The article said

Research suggests that psychotherapists (hereafter also called “therapists”) favor help seekers with the “YAVIS” attributes: young, attractive, verbal, intelligent, and successful (Tryon 1986). Consistent with the YAVIS hypothesis, Teasdale and Hill (2006) found that therapists prefer “psychologically minded” clients and those who share similar values and attitudes. These effects were independent of the demographic characteristics (including race) of the help seekers, but the results were survey based, so social desirability pressures may have influenced the results. In another study, black patients were rated by psychiatrists as “less psychologically minded” as well as “less articulate, competent, [and] introspective” than otherwise equivalent white patients (Geller 1988:124).

The Atlantic article

Not White, Not Rich, and Seeking Therapy

The original study

Kugelmass H. “Sorry, I’m Not Accepting New Patients” An Audit Study of Access to Mental Health Care. Journal of Health and Social Behavior. 2016 Jun;57(2):168-83.


Through a phone-based field experiment, I investigated the effect of mental help seekers’ race, class, and gender on the accessibility of psychotherapists. Three hundred and twenty psychotherapists each received voicemail messages from one black middle-class and one white middle-class help seeker, or from one black working-class and one white working-class help seeker, requesting an appointment. The results revealed an otherwise invisible form of discrimination. Middle-class help seekers had appointment offer rates almost three times higher than their working-class counterparts. Race differences emerged only among middle-class help-seekers, with blacks considerably less likely than whites to be offered an appointment. Average appointment offer rates were equivalent across gender, but women were favored over men for appointment offers in their preferred time range.

eBook_Mindfulness_345x550Preorders are being accepted for e-books providing skeptical looks at mindfulness and positive psychology, and arming citizen scientists with critical thinking skills. 

I will also be offering scientific writing courses on the web as I have been doing face-to-face for almost a decade. I want to give researchers the tools to get into the journals where their work will get the attention it deserves.

Sign up at my website to get advance notice of the forthcoming e-books and web courses, as well as upcoming blog posts at this and other blog sites. Get advance notice of forthcoming e-books and web courses. Lots to see at CoyneoftheRealm.com.


At least 3 reasons you don’t have to read Understanding Psychosis and Schizophrenia 2

Has the British Psychological Society lost its audience for misrepresentatingn of serious mental disorder?

understanding psychosisThe excellent post by Sameer Jauhar and Paul Morrison about the second edition of Understanding Psychosis and Schizophrenia is getting few comments. Perhaps this is because much of the second edition repeats the heavily criticized first edition, while further eliminating citation of research that would prove embarrassing to what is said.



An earlier post by Keith Laws, Alex Langsford, and Samei Huda about first edition was probably among the most accessed Mental Elf blog post ever.

Understanding Psychosis and Schizophrenia (2014) National Elf Service

I took the first edition seriously enough to respond with some heavily accessed posts my own, including one with a slideshow.

“Understanding Psychosis and Schizophrenia” and mental health service users 

Barney Carroll on domesticating psychosis [with slide show providing a detailed, evidence-based critique]

But I’m not to be lured  into a discussion again that goes nowhere with BPS authors who react like vampires to garlic whenever evidence is brought up that contradicts their cherished fixed beliefs.

Thankfully, Sameer Jauhar and Paul Morrison zero in on some key points that show the aversion to debating evidence persists. Here are three, but you can find more in their post.

Unwarranted claims that cognitive behavior therapy has effects equivalent to medication for psychosis.

The [BPS] authors state: Experiencing multiple childhood traumas appears to give approximately the same risk of developing psychosis as smoking does for developing lung cancer.

They cite a study where items on a screening questionnaire correlated with recall of adverse events, with an odds ratio of 11 (Bentall et al., 2012).

They state half of people who experience psychosis will experience problems only once, and recover completely, quoting a review which cites 9 studies.

On average, people gain around as much benefit from CBT as they do from taking psychiatric medication.

The authors cite various meta-analyses, but the effect sizes given are not comparable to those for psychotropic medication, especially when considering effects of blinding, even taking into account criticisms regarding included studies (Jauhar et al., 2014), see below.

The discussion thread on the earlier edition of UPS by Keith Laws and colleague drew heavily on Jauhar et al’ excellent meta analysis to demolish claims about the effectiveness  of CBT. That the authors don’t now cite it at all is telling. I don’t believe in the repression of traumatic memories, but I do believe in authors selectively citing only evidence that fits with their biases.

 Exaggerated claims that trauma is strongly linked to psychosis

The [BPS] authors state:

Experiencing multiple childhood traumas appears to give approximately the same risk of developing psychosis as smoking does for developing lung cancer.

They cite a study where items on a screening questionnaire correlated with recall of adverse events, with an odds ratio of 11 (Bentall et al., 2012).

They state half of people who experience psychosis will experience problems only once, and recover completely, quoting a review which cites 9 studies.


It is mathematically impossible to explain how the factors they give could contribute to the prevalence they mention; the odds ratio for childhood trauma is between 2-4 in most meta-analyses (Morgan and Gayer‐Anderson, 2016) (with methodological limitations). The odds ratio for smoking and lung cancer varies depending on smoking status and cell type, anywhere up to around 100 (Pesch et al., 2012) and evidence they put for a similar association is based on items from a screening questionnaire that measures phenomena that are not related to what people conventionally call psychosis. Even then, the odds ratio of 11 does not sit well with odds given for current smokers and lung cancer.

Put simply, not everyone who experiences psychosis (however defined) has these risk factors, and not everyone who has these risk factors develops psychosis.

Exaggerated recovery rates for schizophrenia and other psychosis

The review stating 50% of people have recovery at follow-up is not a systematic review. A more recent systematic review suggested that only 13% of people with a diagnosis of schizophrenia met the criteria for recovery (Jääskeläinen et al., 2013). Long-term follow-up of people presenting with first episode psychosis show significant heterogeneity in symptomatic and functional outcome: a multi-centre UK first-episode study showing, in geographically defined populations, that 50% were in symptomatic remission at 10 years (a number of whom were taking antipsychotics), though only 15% fulfilled criteria for functional recovery (Revier et al., 2015).

Preorders are being accepted for e-books providing skeptical lookseBook_PositivePsychology_345x550 at mindfulness and positive psychology, and arming citizen scientists with critical thinking skills. Right now there is a special offer for free access to a Mindfulness Master Class. But hurry, it won’t last.

I will also be offering scientific writing courses on the web as I have been doing face-to-face for almost a decade. I want to give researchers the tools to get into the journals where their work will get the attention it deserves.

HappinessCounter, a new digital app that encourages you to smile in your daily life

There is so much wrong with this app from the University of Tokyo and Sony, I don.t know where to start. So, I won’t.

“When she makes a smile, she can use the refridgerator, when she doesn’t smile, she can’t.

HappinessCounter: Smile-Encouraging Appliance to Increase Positive Mood from rkmtlab on Vimeo.


HappinessCounter is a new digital appliance that encourages you to smile in your daily life.

As William James stated, and confirmed by several psychological studies, making smiles positively affects on our mental status — we become happier when we laugh. Inspired by this theory, we propose a new digital appliance that naturally facilitates making smiles in our daily life. This system is mainly designed for people living in alone who have difficulty to realize when they are in low spirits and/or to make themselves smile. Our HappinessCounter combines visual smile face recognition, user feedback, and network communication. We installed this system in a home with a single householder, and the system had positive effects on improving the user’s mental status.

Preorders are being accepted for e-books providing skeptical lookseBook_PositivePsychology_345x550 at mindfulness and positive psychology, and arming citizen scientists with critical thinking skills. Right now there is a special offer for free access to a Mindfulness Master Course. But hurry, it won’t last.

I will also be offering scientific writing courses on the web as I have been doing face-to-face for almost a decade. I want to give researchers the tools to get into the journals where their work will get the attention it deserves.

Sign up at my website to get advance notice of the forthcoming e-books and web courses, as well as upcoming blog posts at this and other blog sites. Get advance notice of forthcoming e-books and web courses. Lots to see at CoyneoftheRealm.com.

Mindfulness: A web-based masterclass



Like many of my loyal followers, I expected my e-book CoyneoftheRealm Takes a Skeptical Look at Mindfulness to be available by now. Though I’m disappointed that it is not, I’m pleased with the progress that has been made and how I have redefined the structure of the e-book.

My progress

Signs of the direction I am now taking with the e-book can be seen in recent blog posts at Mind the Brain and Quick Thoughts, but also in popular talks like the one I gave at this summer’s European Health Psychology Conference in Padova, Italy.

Coyne of the Realm Takes a Skeptical Look at Mindfulness  traces the claims being made about the practice of mindfulness back into the scientific literature in an inimitable style, wittingly challenging conclusions of bad research, but ultimately leaving readers with strategies for judging mindfulness for themselves.

The revised structure now involves discussion of some key papers in detail and provides readers with additional papers they can analyze themselves, with or without the tips I provide.

Feedback I have received suggests this format is a much improved way of providing tools for deciding for one’s self what, and how to think about mindfulness.  The outpouring of new mindfulness papers with even more outrageous claims about changing lives by changing brains continues. If you believe the social media, mindfulness is getting quicker and more powerful. Now you will be prepared for the pitch being made by promoters and be able to take apart what is being claimed and with what evidence.

Sample Chapters

Some basics of evaluating evidence

5. What are the best forms of evidence?

6. Observational studies: correlation does not equal causality

7. Evaluating comparisons of treatments

8. Evaluating reviews

9. Who says so? Importance of promoter bias and conflict of interest

Better than what? Evaluating comparisons between mindfulness and its alternatives

10. Typical clinical trials evaluating mindfulness: Some good, mostly bad

11. Head to head plus: Unusually informative mindfulness trials

12. Some clinical trials for you to evaluate (with hints)

To express my appreciation to those who preorder the book early, I would like to offer a special invitation as well as a free gift. By year’s end, my 100 minute video Master Class on mindfulness will be available for purchase. Although it will sell for $100.00, anyone who has purchased the CoyneoftheRealm Takes a Skeptical Look at Mindfulness book by November 10 will be receiving an email containing a code for a free Mindfulness Master Class video.

In addition, if you preorder the e-book CoyneoftheRealm Takes a Skeptical Look at Mindfulness before November 10, you will  have an opportunity to submit questions to a pool from which those will be drawn to be addresse in a Q&A session at the end of the video.

So,  preorder the mindfulness e-book or the full set of three Coyne of the Realm Takes a Skeptical Look at… and then submit your nominations for questions to be asked in the Q&A session to james@coyneoftherealm.com.


Screening for Distress and Depression vs Optimizing Support and Compassion in Medical Care

My upcoming talks at the Dutch International Congress on Insurance Medicine 2017

screening bookOn Thursday November 9, 2017  I am  pleased to be presenting two talks at the Dutch Society for Insurance Medicine (NVVG) and the Dutch Association of Medical Officers in Private Insurances (GAV) 9th Annual Congress, international day in English on Thursday 9th November 2017.

The Congress is intended for medical officers, insurance and occupational health physicians and others interested in this particular field. Approximately 350 medical doctors in insurance medicine and social benefits are expected to attend. The congress is described as highly appreciated by the participants, and many outstanding and inspiring speakers have contributed over the past years.

I am very pleased to be having another opportunity to present my updated views on screening for depression and distress, as well as whether screening is the optimal way to provide support and compassion in busy routine medical care. Those who are familiar with my work are aware of my skepticism that routine screening improves patient outcomes.

Congress venue:

Van der Valk Hotel Almere

Veluwezoom 45

1327 AK Almere

The Netherlands

Thursday, November 9, 201

9:15- 10:00 Plenary Speaker

The optimal way of providing psychosocial care and care for depression to medical patients


Provision f routine psychosocial care to medically ill patients can be negatively impacted by assuming that basic supportive care needs are primarily mental health issues. Management of depression poses distinct challenges. Care for chronic and acute medical conditions can create competing demands and  disrupt existing care  for depression. Much co-occurring depression apparent during medical care is among patients represents recurrences with recent or past depression care. Much depression care initiated during medical treatment is with inadequate diagnosis, monitoring, and follow up. Optimization of care depends on recognizing depression is largely a chronic, episodic condition with variable course and incomplete remission. The management of depression care can become out of sync with the course of patients’ depression.

14:40- 15:15 Round 1: Parallel sessions

Screening for distress and procedures versus routine compassion in cancer care


Screening for distress among cancer is increasingly mandated internationally without regard to the character of existing health systems and psychosocial care. A lack of robust evidence that screening for distress actually improves patient outcomes is being ignored. The invented concept of “distress” does not map well onto distinct sources of patient discomfort and unmet needs. Depending on the health system, introduction of routine screening can tax existing supportive care and uncover needs that  supportive services cannot address. Access to affordable, accessible care consistent with patient preferences is more challenging that detecting ambiguous “distress” among cancer patients. In moderate to high functioning health systems, exisiting provision of supportive and compassionate care can be disrupted by introduction of screening with a greater emphasis on billable procedures and risk of unnecessary treatment.


Here are a couple of relevant past blog post that you can expect will be updated in my talks:

Where’s the evidence that screening for distress benefits cancer patients? 

Distress- the 6th vital sign for cancer patients?

Psychosocial care focuses too much on young, attractive patients successfully coping with cancer. https://www.coyneoftherealm.com/blogs/mind-the-brain/psychosocial-care-focuses-too-much-on-young-attractive-patients-successfully-coping-with-cancer

And a key review paper with an outstanding group of co-authors:

Thombs BD, Coyne JC, Cuijpers P, De Jonge P, Gilbody S, Ioannidis JP, Johnson BT, Patten SB, Turner EH, Ziegelstein RC. Rethinking recommendations for screening for depression in primary care. Canadian Medical Association Journal. 2012 Mar 6;184(4):413-8.