Contrary to what Toscanini famously said, it’s never too late to apologize.
Ask Shetal Shah. In 2000, Shah, now a professor of pediatrics at New York Medical College’s Maria Fareri Children’s Hospital, in Valhalla, published an essay in JAMA about a young medic providing care to indigenous people in Alaska.
Titled “Five Miles From Tomorrow,” the piece focused on the narrator’s encounter with a wizened 97-year-old Yupik man
with a distinguished air, wearing the omentum of a bowhead whale that has been dried and pressed into a water-resistant parka
According to the piece, the elder and his tribe lived in:
an Arctic afterthought of a human settlement—[that] makes Timbuktu feel metropolitan. Lodged on the tip of an island in the Bering Sea, this 450-person outpost rests on a flat plain of gravel stones and is buried in snow nine months of the year. The closest movie theater is a Slovak cineplex in Eastern Siberia, and proximity to the international date line places the town literally five miles from tomorrow.
Shah admits he took certain “creative liberties” in the piece – license that was pointed out in a letter to the journal shortly after the essay appeared. What were said liberties? For starters, presenting fiction as fact.
At the time Dr Shah’s manuscript was accepted, the editors believed that the essay represented his actual experience. The author’s cover letter of submission states: “The story represents an experience I had an [sic] a visiting medical student in the remote village of Gambell, Alaska.”
It appears that the person who complained to the journal about Shah’s merging of fact and fiction – a “Dr. Swenson” – was on the medical mission with him:
Swenson complains that the story is written as a first-person account; no such event took place during our week in the Arctic. However, this does not mean that such events do not occur in the village I was writing about. Several residents and patients in Nome related similar stories throughout my 5-week stay. As I wrote the story, I was aware of the need to condense events to present a formalized and palatable essay—one that would raise the pertinent issues of medicine and cultural context in a readable format. This was necessary to protect patient confidentiality and falls well within the limits of artistic license. Swenson himself acknowledges both these needs, stating he understands the need to alter events “. . . to make it a better story.” Thus, the ultimate purpose of the story was hopefully served, and the medical community can concentrate more on end-of-life issues and less on stylized writing.
Regardless, Shah, who has not responded to a request for comment from Retraction Watch, now says he has come to realize – two decades later – that the problems with the piece run even deeper:
In light of today’s focus on inclusion and with greater understanding of the effects even unintentional missteps may have on the experience of underrepresented and marginalized populations, I realize this article may have inadvertently reinforced stereotypes or mischaracterized Native American and Alaska Native individuals.
Since publication over 2 decades ago, sensitivity to equity, diversity, and inclusiveness has become even more essential in medicine. Although the content of this story was not meant to be disrespectful, through a modern lens it can be perceived as such. Therefore, I request that the article be retracted. …
Of note: JAMA editor in chief Howard Bauchner stepped down last year after taking responsibility for a tweet and podcast that dismissed concerns about structural racism in medicine.
Shah adds that retracting the essay would be:
a representative action that it is never too late to correct past missteps. As part of a greater societal voyage toward equity/inclusion, I hope this request is an example of a small proactive step toward dismantling pieces of a larger unbalanced system and is part of a broader recognition of the inadvertent ways underrepresented and marginalized populations can be affected. I apologize for any unintentional distress the essay may have caused.
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In his letter, Shah makes an apology for stepping on cultural toes, and violating some tenet of inclusion. I have a bigger beef, since he published an invented incident as if it were fact in a scientific journal. By doing so, he harms the trust placed in him and all of medicine to be honest. Even as a trivial and amusing bit of writing, it brings shame on us. In medicine, as in the outside world, we are increasingly tasked with differentiating science from science fiction.