http://bmj.com/cgi/content/full/323/7311/472/a
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News extra
JAMA falls foul of fabricated suicide story
Deborah Josefson San Francisco
An essay published in JAMA's Piece of my Mind section, has stirred
controversy after it was revealed that the events depicted in it were
fictional.
The essay was written by a medical student, Shetal Shah, and appeared last
October (JAMA 2000;284:1897-8). In his essay, Mr Shah described an
encounter with a 97 year old Inuit man, a toothless elderly member of the
Siberian Yupik tribe, who, feeling useless, came to say goodbye to the young
medical student before committing suicide by walking off into a frozen tundra
in the morning fog.
In a letter to JAMA, Dr Michael Swenson, a physician with Norton
Health Sound in Nome, Alaska, and Shah’s tutor during his elective, denied the
existence of such a patient. Moreover, Dr Swenson charged that Mr Shah’s false
account promulgates false stereotypes about the Inuit people and perpetuates
ancient myths.
Dr Swenson said: "Shah’s article is presented as a true story, when in
fact there is little truth about it... There was no elder who came to us with a
complaint of 'uselessness' or with the intent of 'saying good-bye.' There has
never been a Siberian Yupik tradition that an elder 'bids farewell to his
family and walks over the frozen Arctic Ocean, never to return.' Shah’s story
perpetuates a falsehood that has never been true among the Inuit of Alaska.
Theirs is not "a culture that feels a man is only as valuable as the
wisdom he imparts.' "
Dr Swenson said that he understood Mr Shah’s tweaking of events to make them
more of a story but said that the account was entirely fictional and as such
reflected more of our culture’s prejudices towards elderly people than those of
the Siberian Yupik.
In a letter of reply, Mr Shah defended his essay and said that its purpose
was to focus on end of life issues and that his account reflected a
condensation of similar stories related to him by residents of Nome, during his
five week stay. "This was necessary to protect patient confidentiality and
falls well within the limits of artistic license," he wrote.
Commenting on the essay, Dr Phil Fontanarosa, executive editor of JAMA,
said: "This is a case of an inexperienced author who made a mistake in
judgment. Even though this paper, like all papers in JAMA, underwent
peer review, it’s an example that peer review is not always failsafe,
especially in detecting misrepresentation. While there have been stories that
have been fictional accounts in the past, usually those are clear within the
story. This was presented as an actual experience."
Trevor Jackson, assistant editor at the BMJ, who is
responsible for the BMJ's Personal View section, said: "Patient
confidentiality must be respected, and that is why we would never publish any
material about a patient without a signed consent form from the patient or a
relative. We make clear to authors that fictionalised or disguised accounts are
not acceptable, but sometimes they can be hard to detect. You just have to be alert
and ask questions. You can never let the pursuit of a good story get in the way
of the truth."
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