Can you get fired over the wording of a questionnaire

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From "Researcher to be sacked after reporting high rates of ADHD" Jeanne Lenzer. BMJ (1995, Mar 26) 330 (7493); 691. This article is not currently available without a subscription, but will be available to the general public twelve months after the original publication date.

Dr Gretchen LeFever, a researcher who has claimed that attention deficit hyperactivity disorder in children has been overdiagnosed and overmediciated has been placed on administrative leave with the intent of terminating her employment. Her employer, the East Virginia Medical School, has accused her of scientific misconduct.

"Her work has been controversial. She first made headline news in 1999 when she reported that 8% to 10% of elementary school pupils in southeastern Virginia were being prescribed drugs for ADHD, a percentage two to three times the estimated national average (American Journal of Public Health 1999;89:1359-64).

"Criticism grew after she published the results of a 2002 study showing that the prevalence of the disorder among children in grades 2 to 5 had risen to 17% (Psychology in the Schools 2002; 39: 63-71).

"One of her main critics is Jeffrey Katz, a clinical psychologist in Virginia Beach and the local coordinator of the Children and Adults with Attention-Deficit/Hyperactivity Disorder group. Dr Katz questioned her claim that the condition had been diagnosed in 17% of children in grades 2 to 5.

"He said, 'When somebody like Dr LeFever makes these claims that are apparently not based on good research, it minimises a very real problem. Parents won't bring their children in for evaluation, because they are afraid that medication will be automatically prescribed. They think it's a bad thing and the sole treatment. But medication can have significant benefits.'"

An anonymous whistleblower accused her of scientific misconduct based on her 2002 publication. The survey question asked

"Does your child have attention or hyperactivity problems, known as ADD or ADHD?"

but the publication reported the question as

"Has your child been diagnosed with attention or hyperactivity problems known as ADD or ADHD?"

She has also been accused of conducting research on children without getting parental approval. The local IRB (Institutional Review Board) had originally determined that since only parents and teachers filled out surveys about the children that the children were not research subjects. This meant that the study was exempt from the normal parental approval requirements. After the allegations of scientific misconduct were raised, the medical school sought a second opinion from the national experts at the Office of Human Research Protections. This office ruled that the children were indeed research subjects. This meant that the research was not exempt from parental approval requirements.

Allegations of misconduct often degenerate into a "he said/she said" argument and it is difficult for an outsider to objectively evaluate the evidence. A web search on the name "Gretchen LeFever " will produce a wide range of opinions about her original research and the rationale for her firing.


(1) Is there a serious difference in the reported wording of the questionnaire? Would you expect the first wording to get a higher positive response? Why?

(2) Should a researcher be held responsible for ethical violations for a study that was approved by the local IRB if that approval was later found to be in error?

(3) When a parent fills out a survey about their child, are they implicitly giving permission for their child to be part of the research study? If not, what would constitute permission?

(4) Do you believe that Dr. LeFever is guilty of scientific misconduct? What would be an appropriate punishment?