Systematic Bias in the Progress of Research: The authors analyze the extent to which citing practices may be driven by strategic considerations

Systematic Bias in the Progress of Research. Amir Rubin and Eran Rubin. Journal of Political Economy, Volume 129, Number 9, September 2021. https://www.journals.uchicago.edu/doi/10.1086/715021

Abstract: We analyze the extent to which citing practices may be driven by strategic considerations. The discontinuation of the Journal of Business (JB) in 2006 for extraneous reasons serves as an exogenous shock for analyzing strategic citing behavior. Using a difference-in-differences analysis, we find that articles published in JB before 2006 experienced a relative reduction in citations of approximately 20% after 2006. Since the discontinuation of JB is unrelated to the scientific contributions of its articles, the results imply that the referencing of articles is systematically affected by strategic considerations, which hinders scientific progress.

Alex Tabarrok comments Strategic Citing - Marginal REVOLUTION: Rubin and Rubin have a unique test of this behavior. For administrative reasons, the Journal of Business, a top journal in finance, stopped publication in 2006. Thus, after 2006, there were fewer strategic reasons to cite JOB papers even though the scientific reasons to cite these papers remained constant. The authors test this by matching articles in the JOB with articles in similar journals published in the same year and having the same number of citations in the two years following publication–thus they match on similar articles with a similar citation trajectory. What they find is that post-2006 the citation count of the JOB articles falls substantially off the expected trajectory. [graph]

The finding is robust to controlling for self-citations, own-journal citations, and a variety of other possibilities. The authors also show that deceased authors get fewer citations than matched living authors. For example, living Nobel prize winners get more citations than dead ones even when they were awarded the prize jointly.

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Discussion: Additional implications of the results

In this section, we discuss implications driven by the parallels that exist between academic research and firm innovation. First, citations of patents may also be subject to strategic citations (of different sorts), which requires caution in inferences made in innovation studies. Second, we suggest that if authors of academic studies were to include more information on references cited (as done in patent applications), it could potentially benefit academic research and help reduce adverse citing practices. The finance literature has recently seen a growth in studies devoted to innovation (Lerner and Seru, 2017). Most researchers use two types of proxies to measure the innovation output of a company: the number of patents it is granted (e.g., in a given year) and the number of citations its granted patents receive following their approval.32 The disadvantage of the former proxy is that not all patents are of similar quality, so the latter is widely considered the better proxy for the scientific contribution of the firm.33 In the literature, patent citation counts are most often considered an (exogenous) outcome determined by the innovation of the firm or its CEO. However, citation counts of patents may be affected by strategic considerations of the firms citing them. Consider, for example, the relation between the decision to go public and the firm’s future innovation (Acharya and Xu, 2017; Bernstein, 2015). Once a firm becomes public, it is more visible, has more resources, and is likely to be serviced by more competent attorneys. It is possible that these facts may lead its competitors to cite the public firm’s patents more often (compared to its pre-IPO period), because after its IPO, the company is more likely to be capable of suing others for violating its intellectual property rights. Hence, if the researcher observes a higher level of citation counts in the post-IPO period, it may be due to not only a higher level of innovation in the post-IPO period but also to a change in the citing behavior of its competitors. Similarly, citing practices may change after a merger not only because of synergies (Bena and Li, 2014) but also because former rivals become cooperators, which may alter the strategic citing behavior. There is also evidence that patents of firms with overconfident CEOs obtain more citations (Hirshleifer, Low, and Teoh, 2012). It would be interesting to learn the extent to which the citations differ due to these CEOs’ preference to engage in risky innovations and the extent to which competing firms change their citing behavior because they are more wary of overconfident CEOs’ aggressiveness, which may lead to prosecution in courts. The strategic citing behavior that we uncover seems to be facilitated by the difficulty associated with monitoring it, as more trivial, easy to monitor, agency related citations, as in the case of citing editors' papers, do not seem to be pervasive in the data (see the appendix B analysis). As such, adverse citing practices of top-tier publications can benefit by borrowing from the higher level of resolution in information that currently exists in patent applications. References of patents are classified as either provided by the inventor (firm) or by the examiner of the patent. If one wants to follow the knowledge trail of the innovation process, only the inventors’ citations matter, because the examiners’ citations are added only ex-post, after the patent was actually filed (Alcacer and Gittelman, 2006). In academic research, the situation is similar in that cited references are not equally important for a given study. Some of the cited papers are building blocks for arguments, some yield similar conclusions, and some provide opposing interpretations. Most importantly, some papers overturn a previous result because of a possible mistake or an overlooked fact stated in that previously published paper. Similar to patent citation categorization, it could be helpful if academic authors are required to classify their references in terms of the way they were used in their research. A recent paper by Catalini, Lacetera, and Oettl (2015) suggests that even a simple characterization of references in terms of whether they are cited based on their contributions or flaws can increase the field’s understanding of the merits of research articles. It is possible that if authors were to indicate their perception of their references’ categories, the relevance of the cited work would become clearer, and consequently, the academic research process would improve. A reference categorization process should reduce the tendency of authors to engage in agency citations, and monitoring of the classification may become one of the important tasks of referees. Related to this, it may be worthwhile to provide some descriptive information about the references, such as the fraction of top-tier articles in the list (a high fraction may be indicative of a adverse citing practices) and the number of cases in which a reference is a sole contributor to a particular point (possible evidence of negligence of others). Finally, based on our findings of increased agency citations as the number of authors increase, it may be beneficial to require the identification of the author that is responsible for the integrity of the reference list so that it relates to the appropriate previous work. For example, it may be stated that the corresponding author is the responsible entity for this issue.

 32 Kogan et al. (2017) provide evidence that a measure of market reaction to patents is able to better explain economic growth stemming from the patent than citation counts (e.g., Moser, Ohmstedt, and Rhode, 2018; Abrams, Akcigit, and Popadak, 2013). One possibility for this is that strategic citations distort the citation count measure from reflecting a patent’s scientific value.

33 Note that in academic research, the number of publications (analogous to the number of patents) is often perceived as a poor measure of an author’s contribution, and measures such as h-10 (Google Scholar) ignore publications with no citations. This raises the question of whether the benefits of having two measures for robustness, as commonly done in the innovation literature, outweigh the costs of a noisy measure that can yield different results. In fact, one could use the differences between the two measures for a better identification of the strategic aspects of the innovation process. For example, it is known that firms may issue a patent not to open a new field (which tends to lead to future citations) but rather as a boundary of scope to prevent others from pursuing inventions in a certain area. The difference between the two measures could potentially proxy for such a tendency.

Neurodualism... People Assume that the Brain Affects the Mind more than the Mind Affects the Brain, & distort claims about the brain from the wider culture to fit their dualist belief that minds and brains are distinct, interacting entities

Neurodualism: People Assume that the Brain Affects the Mind more than the Mind Affects the Brain. Jussi Valtonen, Woo-kyoung Ahn, Andrei Cimpian. Cognitive Science ,September 7 2021. https://doi.org/10.1111/cogs.13034

Abstract: People commonly think of the mind and the brain as distinct entities that interact, a view known as dualism. At the same time, the public widely acknowledges that science attributes all mental phenomena to the workings of a material brain, a view at odds with dualism. How do people reconcile these conflicting perspectives? We propose that people distort claims about the brain from the wider culture to fit their dualist belief that minds and brains are distinct, interacting entities: Exposure to cultural discourse about the brain as the physical basis for the mind prompts people to posit that mind–brain interactions are asymmetric, such that the brain is able to affect the mind more than vice versa. We term this hybrid intuitive theory neurodualism. Five studies involving both thought experiments and naturalistic scenarios provided evidence of neurodualism among laypeople and, to some extent, even practicing psychotherapists. For example, lay participants reported that “a change in a person's brain” is accompanied by “a change in the person's mind” more often than vice versa. Similarly, when asked to imagine that “future scientists were able to alter exactly 25% of a person's brain,” participants reported larger corresponding changes in the person's mind than in the opposite direction. Participants also showed a similarly asymmetric pattern favoring the brain over the mind in naturalistic scenarios. By uncovering people's intuitive theories of the mind–brain relation, the results provide insights into societal phenomena such as the allure of neuroscience and common misperceptions of mental health treatments.

7 General discussion

We investigated intuitive theories of minds and brains in five studies with both lay participants and professional psychotherapists. We hypothesized that when reasoning about minds and brains, people rely on neurodualism—a hybrid intuitive theory that assimilates aspects of physicalist beliefs into pre-existing dualist intuitions, attributing more causal power to the brain over the mind than vice versa.

In all experiments and across several different tasks involving both thought experiments and naturalistic scenarios, untrained participants believed that interventions acting on the brain would affect the mind more than interventions acting on the mind would affect the brain, supporting our proposal. This causal asymmetry was strong and replicated reliably with untrained participants. Moreover, the extent to which participants endorsed popular dualism was only weakly correlated with their endorsement of neurodualism, supporting our proposal that a more complex set of beliefs is involved. In the last study, professional psychotherapists also showed evidence of endorsing neurodualism—albeit to a weaker degree—despite their scientific training and stronger reluctance, relative to lay participants, to believe that psychiatric medications affect the mind.

Our results both corroborate and extend prior findings regarding intuitive reasoning about minds and brains. Our results corroborate prior findings by showing, once again, that both laypeople and trained mental health professionals commonly hold dualistic beliefs. If their reasoning had been based on (folk versions of) a physicalist model, such as identity theory or supervenience, participants should not have expected mental events to occur in the absence of neural events. However, both lay participants and professional psychotherapists did consistently report that mental changes can occur (at least sometimes) even in situations in which no neural changes occur.

Our findings also extend prior findings by demonstrating that intuitive theories of minds and brains are considerably more complex than has previously been acknowledged. While it is widely agreed that dualistic beliefs are common (Ahn et al., 2017; Bloom, 2004; Forstmann & Burgmer, 2015; Miresco & Kirmayer, 2006; Mudrik & Maoz, 2014; Stanovich, 1989), how exactly people reason about the mind and brain in relation to each other has remained unclear. Our findings show that the fuller picture of intuitive theories is more nuanced than a mere belief that the mind and the brain are separate interacting entities. That intuitive theories can contain aspects of both popular-dualist and physicalist beliefs helps to explain why people's beliefs often seem internally inconsistent: While people often agree with the statement that the mind is not separable from the brain, they also endorse the view that the mind is not fundamentally physical (Demertzi et al., 2009). Similarly, even professional neuroscientists—who presumably endorse physicalist views—commonly discuss the brain in terms that conflict with physicalism (Greene, 2011; Mudrik & Maoz, 2014). Inconsistencies such as these are to be expected if people intuitively think of the mind as neither purely physical nor entirely independent of the brain, but rather embrace aspects of both of those views simultaneously. In fact, it is not uncommon for intuitive theories to take the form of hybrids that incorporate novel beliefs into existing theories whose original core is not lost even as the theories become increasingly complex (e.g., Hussak & Cimpian, 2019; Shtulman & Lombrozo, 2016).

Moreover, the current study sheds light on what this hybrid theory looks like. The results suggest that even if (and when) people are dualists, they perceive the brain neither as causally irrelevant for the mind nor as unresponsive to mental changes, but rather see the brain as a more commanding and robust causal agent than the mind. Future research will hopefully be able to capture further subtleties in intuitive theories of minds and brains. It seems likely that if researchers search for more fine-grained options than dichotomous dualist/antidualist positions in lay intuitions, increasingly fine-grained aspects may become visible.

7.1 Broader implications for theory and practice

7.1.1 Relation to the popular allure of neuroscience

Our findings may help to explain the intense fascination that the general public and mass media show for neuroscience research (Beck, 2010; O'Connor, Rees, & Joffe, 2012). If the general public is reluctant to believe that changes in the mind always correspond to changes in the brain, neuroscience findings showing that what happens in our minds happens in our brains as well contradict this belief and may thereby be particularly intriguing. Neurodualism may also help explain why people find brain-related statements informative in the context of psychological explanations even when the statements are irrelevant (Weisberg, Keil, Goodstein, Rawson, & Gray, 2008; Fernandez-Duque, Evans, Christian, & Hodges, 2015). Conceivably, the intuitive tendency to privilege causal patterns in the brain-to-mind direction (i.e., neurodualism) may bias people to perceive causal brain-to-mind connections even when none exist, which may in turn make the addition of neuroscience evidence to a psychological explanation seem informative. Also consistent with this argument, Fernandez-Duque et al. (2015) found that (popular) dualistic beliefs alone did not predict their participants’ reasoning in these contexts. In future research, it would be useful to test whether endorsement of neurodualism does predict the tendency to view information about the brain as particularly explanatory even in cases where it is not.

On a different note, some authors have suggested that the allure of neuroscience explanations is not specific to beliefs about minds and brains but related to a more general preference for reductive information. Hopkins, Weisberg, and Taylor (2016) found that across different scientific disciplines, people generally preferred explanations that referred to processes perceived as more fundamental, even when these processes were logically irrelevant to the explanation. According to this view, information about the brain may be seen as particularly informative because it is perceived as operating at the next level of analysis below psychological phenomena (Fernandez-Duque, 2017). It seems likely, however, that the neurodualist intuitive theory identified in the present research and this general preference for reductive information are independent inputs into the public's fascination with neuroscience explanations. Importantly, neurodualism itself is not a reductionist theory: For instance, people report that changes in mental states are only sometimes accompanied by changes in brain states (see Studies 3–5). Beliefs such as these are not easily interpreted as evidence that people are treating the terms “mind” and “brain” as referring to the same phenomenon at different levels of analysis. A more plausible account is that a neurodualist intuitive theory and the preference for reductive explanations are two independent factors contributing to the public appeal of neuroscience.

7.1.2 Implications for reasoning about mental illness and health

The current results may help to make sense of common beliefs regarding treatment efficacy in mental health. When people think that the source of a mental health issue such as depression is in the brain, they perceive psychological interventions as less likely to be helpful (Ahn et al., 2017; Deacon & Baird, 2009; Kemp et al., 2014). The belief that a psychological treatment cannot be effective if the problem is reflected in brain processes is at odds with both a physicalist view of the mind and the empirical evidence (e.g., Linden, 2006; Lozano, 2011; Deacon, 2013). These beliefs are unfortunate from a practical viewpoint as well because prognostic beliefs often predict treatment outcomes (Rutherford, Wager, & Roose, 2010). That is, pessimistic expectancies can become self-fulfilling prophecies: Neurobiological causal attributions are associated with both lower treatment expectations and poorer psychosocial treatment outcomes in depression (Schroder et al., 2020). Our findings suggest that part of the reason for these effects may lie in the intuitive theories people use for reasoning about the mind and brain. Biological causal explanations may foster pessimism about the efficacy of psychotherapy partly because of an underlying intuitive theory ascribing relatively little power to the mind over the brain.

Fortunately, targeted education about the malleability of neurobiological factors in depression can help reduce prognostic pessimism and strengthen patients’ beliefs about their own ability to regulate their moods in depression (Lebowitz & Ahn, 2015), suggesting that these intuitions are not fixed or immutable. In future work, it would be worthwhile to investigate whether interventions that target people's intuitive theories of the relation between the mind and brain could also help mitigate the negative consequences of biological attributions for disorders such as depression.

While participants in our studies were reluctant to believe that acting on the mind can result in changes in the brain, they were more willing to endorse that acting on the brain can result in changes in the mind. This may help, in part, to explain why Western societies have so enthusiastically come to favor neurobiologically centered approaches to mental illness despite people's dualistic intuitions. Pharmacological treatments have become the predominant societal response to mental health conditions over the past decades. Although it is widely agreed that an adequate response to mental distress needs to address several nonreducible levels, Western cultures have allowed “the biopsychosocial model to become the bio-bio-bio model,” in the words of a previous president of the American Psychiatric Association (Sharfstein, 2005). Arguably, neither the enthusiasm nor the scale at which this approach has been implemented is easy to explain from a purely evidence-based perspective (Deacon, 2013; Whitaker & Cosgrove, 2015; UN Human Rights Council, 2017; Lacasse & Leo, 2005; Healy, 2015; Moncrieff & Cohen, 2006), and its success has been controversial at best (Danborg & Gøtzsche, 2019; Gøtzsche, Young, & Crace, 2015; Haslam & Kvaale, 2015; Hengartner, 2020; Ioannidis, 2019; Jakobsen et al., 2017; Munkholm, Paludan-Müller, & Boesen, 2019; Sohler et al., 2015). Why, then, do we continue to operate based “on faith that neuroscience will eventually revolutionize mental health practice,” if “[d]ecades of extraordinary investment in biomedical research have not been rewarded with improved clinical tools or outcomes” (Deacon, 2013, p. 858)? While numerous societal and institutional factors undoubtedly affect the situation in all its complexity (e.g., Moncrieff, 2006; Whitaker & Cosgrove, 2015), from a strictly cognitive perspective, it is conceivable that our intuitive theories—in particular, our willingness to believe in the brain as an asymmetrically powerful causal agent that can influence the mind—may have contributed and made the public prone to believe overstated neuroscientific claims. In a self-reinforcing cycle, the widescale implementation of any neurobiologically centered practices likely also loops back and shapes people's intuitive theories in ways that further increase the appeal of these practices.

7.1.3 Relation to the broader historical context

The intuitive theories documented here are undoubtedly a product of the current historical context: Several authors have suggested that many cultures are undergoing a transition toward understanding mind–brain relations in more materialistic terms (e.g., Mudrik & Maoz, 2014). As scientific inquiry has progressed, we as a culture have increasingly come to believe that it is the brain which controls faculties formerly associated with the soul, such as memory, language, and emotion. If the suggestion is correct that we are in the process of intuitively giving up the mind's and/or soul's functions to material brains (Greene, 2011), it is interesting to consider what are “the soul's last stands”—the most immaterial of our nonphysical capacities, the ones not yet outsourced to the brain.

7.2 Conclusion

It is important to keep in mind that, philosophically, the mind–body problem remains an unresolved paradox. Although materialist and physicalist views have been the working assumption of contemporary psychologists and neuroscientists and also the prevailing position in philosophy over the past decades, this does not mean that the original mind–body problem itself was resolved. It remains, to this day, extremely difficult to see how, if the mind is a nonphysical thing and the body is a physical thing, one could simply just be the other (or how they could interact, if we are dualists). It is helpful to remember that not only the general public but also (at least some) contemporary philosophers find the claim inherently implausible that the mind simply is a physical thing (e.g., Westphal, 2016). What people think the mind is, however, and how exactly they think it is related to the brain seems worth investigating further, both for theoretical and practical reasons.

Pandemics Initially Spread Among People of Higher (Not Lower) Social Status: Evidence From COVID-19 and the Spanish Flu

Pandemics Initially Spread Among People of Higher (Not Lower) Social Status: Evidence From COVID-19 and the Spanish Flu. Jana B. Berkessel et al. Social Psychological and Personality Science, September 7, 2021. https://doi.org/10.1177/19485506211039990

Abstract: According to a staple in the social sciences, pandemics particularly spread among people of lower social status. Challenging this staple, we hypothesize that it holds true in later phases of pandemics only. In the initial phases, by contrast, people of higher social status should be at the center of the spread. We tested our phase-sensitive hypothesis in two studies. In Study 1, we analyzed region-level COVID-19 infection data from 3,132 U.S. regions, 299 English regions, and 400 German regions. In Study 2, we analyzed historical data from 1,159,920 U.S. residents who witnessed the 1918/1919 Spanish Flu pandemic. For both pandemics, we found that the virus initially spread more rapidly among people of higher social status. In later phases, that effect reversed; people of lower social status were most exposed. Our results provide novel insights into the center of the spread during the critical initial phases of pandemics.

Keywords: social status, pandemic spread, COVID-19, Spanish flu

Discussion

According to a staple in the social sciences, people of lower social status are particularly exposed to pandemics (O’Sullivan & Bourgoin, 2010; von Braun et al., 2020). Acknowledging that pandemics evolve in phases (World Health Organization, 2017; Zhang et al., 2020), we provided a more nuanced account. Specifically, we proposed that during the critical initial phases of pandemics, people of higher (not lower) social status are at the center of the spread. Our research builds on established social status theory in social psychology: People of higher social status exhibit more independent behavior, are more mobile, and possess more diverse social networks; people of lower social status exhibit more interdependent behavior, are less mobile, and possess more homogenous social networks (Carey & Markus, 2017; Kraus et al., 2012; Thomson et al., 2018). Further, our research helps reconcile findings from the ongoing COVID-19 pandemic that appeared contradictory (Drefahl et al., 2020; Mogi et al., 2020). Finally, our research makes much-needed progress toward a distinctively psychological theory of pandemics (Betsch, 2020; Van Bavel et al., 2020).

Across three nations, two pandemics, two levels of analysis, and different data sources, we found full support for our hypothesis. Study 1 used region-level infection data and showed that in the initial phases of the COVID-19 pandemic, the virus spread primarily in higher income regions. In the later phases of the pandemic, however, the virus spread primarily in lower income regions. Study 2 showed that the 1918/1919 Spanish Flu pandemic in the United States initially spread more strongly among people of higher social status. Later on, by contrast, the pandemic spread most strongly among people of lower social status. Study 2 relied on a unique historic data set of millions of memorials, which we web-harvested using the latest social data science techniques. As such, the study highlights the potential of adding a historical perspective to derive insights into pandemic processes (Hatchett et al., 2007) and showcases the potential of social data science to scrutinize such historical data at large scale (Adjerid & Kelley, 2018; Kosinski & Behrend, 2017). By combining large-scale contemporary data and historical data, our work is one of the few psychological studies that examines historic events (Arnett, 2008; Muthukrishna et al., 2021). A limitation of our work is its focus on three Western, developed nations (Henrich et al., 2010a, 2010b). Accordingly, it will be an important task for future research to probe whether our findings extend to non-Western, less developed nations.

The COVID-19 pandemic hit the world underprepared (Remuzzi & Remuzzi, 2020; Walker et al., 2020). Hence, far-reaching societal decisions had (and still have) to be made under great uncertainty. Our study aims at reducing these uncertainties and ultimately at improving allocation of resources. We provide a more nuanced understanding of the initially most exposed societal strata during pandemics, informing both, scientific theory and real-world decision making. In fact, our findings have actable implications for containment efforts: First, people of higher social status are at the center of the initial spread. As such, higher income regions should probably be a focus of outbreak monitoring whenever a new pandemic seems to rise. Second, the longer pandemics last, the more they will spread among people of lower social status. Importantly, our results suggest that previous research might even have underestimated the risk people of lower social status face at later pandemic phases. This is so because previous estimates did not differentiate between earlier and later phases and, thus, lumped together their opposed effects.

As we write this article, we are amid a second COVID-19 wave. It, therefore, remains an important task for future research to examine whether our results generalize to later waves. Recall that our theoretical reasoning rests on the preconditions that (a) the virus is not yet widespread and that (b) social behaviors are unrestricted. These preconditions are necessarily fulfilled during the initial phases of a pandemic’s first wave. Regarding later pandemic waves, however, it is less clear whether those preconditions are fulfilled. On the one hand, in many nations, the virus was almost entirely contained, and life has largely gone back to normal in-between COVID-19 waves (e.g., reopened restaurants, hotels, and shopping centers). From this perspective, first and later waves might show similar spreading patterns (i.e., initial spread among higher social status people in both waves). On the other hand, social behaviors were never entirely reset to their prepandemic state (e.g., mask-wearing, avoidance of large gatherings, and restricted flying). Furthermore, the virus survived at low levels in-between the waves in all societal strata. If anything, it probably survived better among people of lower social status. From this perspective, first and later waves might show different spreading patterns (i.e., initial spread among higher social status people in the first wave, but initial spread among lower social status people in later waves). Considering these competing perspectives, there might be no universal answer to the question of whether first and later waves initially spread similarly across societal strata. Rather, the spreading patterns of later waves more likely depend on a nation’s specific pandemic trajectory (e.g., consider the United States that never contained the virus vs. Germany that almost entirely contained the virus in-between waves).

Taken together, our findings hint at a most relevant (and tragic) dynamic: While people of higher social status may import novel viruses and cause their initial spread, people of lower social status carry the major burden once the pandemic unfolds. Importantly, this spread among people of lower social status during later pandemic phases is particularly consequential. Specifically, people of lower social status not only suffer from reduced access to health resources (which leads to a higher death toll) but will also need longer to economically recover from a pandemic crisis (which perpetuates existing social inequalities; Walker et al., 2020). Importantly, our findings highlight that these adverse effects for people of lower social status may be preventable. Specifically, if containment measures are implemented early and rigorously, it might be possible to stop pandemics before they reach the most vulnerable societal strata.

Negative plastic surgery effect: Women seeking plastic surgery were perceived less favorably than those planning to complete control activities across all outcome variables (warmth, competence, morality, & humanness)

Bonell S, Murphy SC, Griffiths S (2021) Under the knife: Unfavorable perceptions of women who seek plastic surgery. PLoS ONE 16(9): e0257145, Sep 7 2021. https://doi.org/10.1371/journal.pone.0257145

Abstract: Plastic surgery is growing in popularity. Despite this, there has been little exploration to date regarding the psychosocial consequences of seeking plastic surgery. Our study investigated how women seeking plastic surgery are perceived by others. We presented a random sample of 985 adults (men = 54%, Mage = 35.84 years, SDage = 10.59) recruited via Amazon’s Mechanical Turk with a series of experimental stimuli consisting of a photographed woman (attractive versus unattractive) and a vignette describing an activity she plans to engage in (plastic surgery versus control activity). Participants rated stimuli on perceived warmth, competence, morality, and humanness. We ran linear mixed-effect models to assess all study hypotheses. There was a negative plastic surgery effect; that is, women seeking plastic surgery were perceived less favorably than those planning to complete control activities across all outcome variables (warmth, competence, morality, and humanness). These relationships were moderated by physical attractiveness; while attractive women planning to undergo plastic surgery were perceived less favorably than attractive women planning to engage in control activities, perceptions of unattractive individuals remained unchanged by plastic surgery status. We theorized that empathy toward unattractive women seeking plastic surgery mitigated the negative plastic surgery effect for these women. In sum, our results suggest that perceptions of attractive women are worsened when these women decide to seek cosmetic surgery. Perceptions of warmth and competence have implications for an individual’s self-esteem and interpersonal relationships, while perceptions of morality and humanness can impact an individual’s ability to fulfil their psychological needs. As such, we concluded that attractive women seeking plastic surgery are potentially subject to experience negative psychosocial outcomes. Future research ought to examine whether perceptions and outcomes differ for women seeking reconstructive plastic surgery (versus cosmetic plastic surgery) and whether they differ across different types of surgeries (i.e. face versus body).

Discussion

Hypothesis 1 (primary hypothesis): The negative plastic surgery effect

The present study built on existing literature by examining whether women seeking plastic surgery are systematically perceived differently to other women. We hypothesized that there would be a negative plastic surgery effect; that is, women planning to have plastic surgery would be considered less warm, competent, moral, and human than those planning to complete control activities. Results largely supported this hypothesis. Importantly, this study was the first of its kind in which perceptions of women planning to undergo plastic surgery were explored (where focus has previously been on perceptions of women who had already undergone plastic surgery). As such, the present study demonstrates that negative attitudes toward plastic surgery extend specifically to plastic surgery itself, and not just to its associated outcomes; that is, negative attitudes toward plastic surgery are not dependent on how women look or feel after surgery, but rather pertain simply to the decision to undergo plastic surgery in the first place. Implications for women seeking plastic surgery are discussed below.

Low warmth and competence: A recipe for contempt.

The Stereotype Content Model proposes that we form impressions of others by assessing them across two fundamental dimensions: warmth and competence [38, 54]. In this model, individuals are perceived as belonging to one of four quadrants: High Warmth-Low Competence, High Warmth-High Competence, Low Warmth-High Competence, or Low Warmth-Low Competence. Correlational and experimental evidence has demonstrated that the way in which people relate to members of each quadrant is unique [54]. For instance, the Low Warmth-Low Competence quadrant is said to house ‘free-loaders’ who induce contempt [37, 38]. In line with our hypothesis, plastic surgery stimuli were considered both less warm and less competent than non-plastic surgery stimuli in the present study. As such, we infer that by choosing to undergo plastic surgery, women might be subject to contempt. In work contexts, receiving contemptuous feedback has been associated with decreased self-esteem and increased interpersonal aggressiveness toward colleagues [55]. Likewise, feelings of contempt are one of the primary predictors of marital breakdown [56, 57]. As such, women seeking plastic surgery (and, by extension, inducing contempt) may face implications both interpersonally and professionally.

Immorality, dehumanization, and psychological needs.

Results indicated that plastic surgery stimuli were rated lower on morality and humanness traits than non-plastic surgery stimuli, supporting our hypothesis. Literature has suggested that ‘feeling moral’ ought to be categorized as a basic psychological need. Specifically, Prentice and colleagues [58] found that having a positive perception of one’s own morality was uniquely predictive of wellbeing over and above the effect of fulfilling traditional psychological needs (i.e. autonomy, relatedness, and competence). In line with socialization theory (whereby the beliefs of those around us heavily inform our own), we induce that women considering plastic surgery may struggle to ‘feel moral’ if others perceive them to be morally questionable [59]. In turn, they may experience worsened wellbeing relative to if they were not seeking plastic surgery. Similarly, our results suggest that plastic surgery is dehumanizing. While existing literature has extensively explored the motivations preceding dehumanization, relatively less attention has been paid to the consequences of dehumanization for victims. That said, there is some evidence to suggest that being dehumanized negatively impacts one’s ability to meet four psychological needs: perceived control, meaningful existence, sense of belonging, and self-esteem [45]. Further, dehumanized people may experience less empathy from others and be targets for aggression [46]. Therefore, we conclude that dehumanized plastic surgery recipients may face negative psychosocial outcomes.

Hypothesis 2: Justice sensitivity and disgust sensitivity as moderators for the negative plastic surgery effect

Beyond simply establishing the existence of a negative plastic surgery effect, the present study also sought to explain for whom this effect was strongest. Specifically, we hypothesized that the negative plastic surgery effect would be greater for participants higher in justice sensitivity and disgust sensitivity; that is, those more sensitive to injustice and disgust would perceive women intending to have plastic surgery less favorably. This hypothesis was not supported by results. Firstly, contrary to existing literature, these findings do not support the theory that the negative plastic surgery effect is driven by concerns pertaining to recipients reaping ‘unearned’ rewards from plastic surgery (i.e. the concern that plastic surgery is ’cheating’) [11]. Further, also in contrast with existing literature, these findings do not support the theory that the negative plastic surgery effect is driven by stigmatization toward individuals with non-normative bodies [31, 33, 60, 61]. We note, however, that in the present study, stimuli described as having had plastic surgery did not necessarily look non-normative (i.e. they did not look different to control stimuli). As such, we cannot definitively conclude that perceptions of disgust do not drive the negative plastic surgery effect in cases where women have visibly undergone surgery (e.g., they look ‘artificial’); rather, only in cases where plastic surgery status becomes known via vignette.

Hypothesis 3: ‘What is beautiful is good’

Existing literature demonstrates that the social consequences of being attractive are overwhelmingly positive [22–26]. As such, we hypothesized unattractive stimuli would be perceived as less warm, competent, moral, and human than attractive stimuli. This hypothesis was supported by results. These findings contributes to an extensive and growing body of literature that demonstrates that ‘what is beautiful is good’.

Hypothesis 4: Exploratory hypotheses

Hypothesis 4a.

Next, we assessed the exploratory hypothesis that the negative plastic surgery effect would be moderated by patient attractiveness; that is, we examined whether attractive and unattractive women planning to have plastic surgery were both subject to similar negative plastic surgery effects. Results indicated that the negative plastic surgery effect applied exclusively to attractive plastic surgery recipients. To elaborate, person perception for unattractive individuals remained unchanged by plastic surgery status (e.g., an unattractive woman planning to have a conversation and an unattractive woman planning to have plastic surgery were perceived similarly), while attractive plastic surgery stimuli were perceived as less warm, competent, moral, and human than attractive non-plastic surgery stimuli.

Because empathy plays a crucial role in reducing stigmatization, we theorize that empathy might explain the revealed interaction between plastic surgery status and stimuli attractiveness [62–67]. Intuitively, individuals may feel that it is more ‘understandable’ that unattractive women might seek plastic surgery. Given that both the present study’s results and existing literature suggest that unattractive women are perceived to be less warm, competent, moral, and human than attractive women, it may seem reasonable for these women to want to undergo plastic surgery to reduce their experiences of appearance-based stigmatization [9, 22]. Conversely, participants may have less empathy for attractive women who do not stand to face the same stigmatization with or without surgery. In line with this theory, existing literature has demonstrated that people feel more empathy toward unattractive individuals (versus attractive individuals) across a variety of situations because they are more easily able to believe that unattractive individuals are suffering or in need of help [66, 67]. As such, we propose that there unattractive stimuli in the present study were not subject to the negative plastic surgery effect because participants were more easily able to empathize with them.

Hypothesis 4b.

Given that our hypothesis 4a was supported, we subsequently examined whether participant justice sensitivity and/or disgust sensitivity would influence the interaction between plastic surgery status and attractiveness. This exploratory hypothesis, however, was not supported by results. As such, we concluded that neither justice sensitivity nor disgust sensitivity influenced the phenomenon whereby solely attractive individuals were subject to the negative plastic surgery effect.

Limitations

There were some limitations for the present study. Firstly, we note that the plastic surgery vignette used in our study (“this woman is planning to have plastic surgery”) neither specified the nature of the plastic surgery the woman was planning to have, nor the specific surgery performed. We assumed (but did not ensure) that participants would respond to our measures with regard to cosmetic plastic surgery as opposed to reconstructive plastic surgery, given that the faces presented in our stimuli did not look disfigured in any way. We also did not specify whether the plastic surgery in question was for the face (e.g., rhinoplasty) or body (e.g., abdominoplasty), nor provide any other information pertaining to the surgery (e.g., whether she was planning to have one surgery or multiple). As such, the biggest limitation for the present study is that we cannot say with certainty whether the perceptions measured are in relation to cosmetic plastic surgery or reconstructive plastic surgery (or both), and/or whether different specific surgeries would elicit different attitudes from participants (e.g., face vs body).

We also note limitations in the generalizability of our conclusions. The means on all outcome measure scales used in the present study were consistently above the mid-point, regardless of plastic surgery condition, and our effect sizes were consistently small. In other words, while there were statistically significant differences between perceptions of women who seek surgery and women who do not across all outcome measures, the absolute difference in perceptions of these women were minimal. As such, negative outcomes faced by women seeking plastic surgery may ultimately be small, though still significant and important. Speaking further to the generalizability of the study, we note that only White plastic surgery stimuli were used. These findings therefore cannot be generalized to people of color; specifically, we are unable to establish whether plastic surgery recipients who are people of color are subject to the negative plastic surgery effect. Given that plastic surgery has historically attempted to produce more stereotypically White features (e.g., surgeries for the ‘Jewish nose’ or ‘Black nose’), it is especially important that we acknowledge the limited applicability of our findings [32, 68].

Implications, conclusions, and future directions

The present study demonstrates the existence of a negative plastic surgery effect, specifically for attractive women. In planning to undergo plastic surgery, these women are perceived as less warm, moral, competent, and human. As such, we contend that attractive women seeking plastic surgery may find themselves experiencing negative psychosocial outcomes (e.g., being subject to contempt). However, we note that at present these outcomes are purely speculative, and that future research is needed to test these associations. As per our limitations section, future research also ought to examine the negative plastic surgery for cosmetic plastic surgeries and reconstructive plastic surgeries separately, and for different types of surgeries (e.g., face vs body). Future research might also explore additional consequences that women subject to the negative plastic surgery effect are likely to face. For example, might this worsened person perception result in social exclusion or prejudicial treatment? Finally, future research need address whether these results are generalizable to non-White plastic surgery recipients. Overall, our study was the first to examine the negative plastic surgery effect experimentally. We provide a fundamental starting point from which future literature can further investigate negative plastic surgery attitudes in order to inform both women seeking plastic surgery and plastic surgeons themselves.