CHICAGO -- The distinguished Journal of the American Medical Association says it got duped into publishing a medical student's phony account of an elderly Alaskan villager walking out onto the frozen Arctic Ocean to commit suicide.
Shetal I. Shah had presented his bleak essay, published Oct. 18, as factual. But in a letter in Wednesday's JAMA, Shah's former supervisor said that there was no such suicide victim and that the story perpetuates a myth about a tradition that does not exist.
Shah's account was published as one of JAMA's ''A Piece of My Mind'' columns, in which doctors detail the emotional side of medicine.
Shah described a proud, toothless 97-year-old patient at a remote Alaskan medical clinic where Shah worked briefly. The man, a member of a Siberian Yupik village, came to say goodbye before vanishing ''into the early morning fog,'' Shah wrote.
In a letter in Wednesday's journal, Shah defended the essay, saying it was based on stories he had been told by residents during his stay. He said he created the tale to highlight pertinent ''end-of-life issues.''
In some arctic cultures, elders sometimes voluntarily froze to death on the ice in times of village hardship, said Ernest Burch, an anthropologist affiliated with the Smithsonian Institution. But that was a 19th-century custom that no longer exists, Burch said.
Shah's former supervisor, Dr. Michael Swenson, a physician with Norton Sound Health Corp. in Nome, said the story presents a hurtful stereotype about current Yupik society, where despair among the elderly is far less common than among urban cultures.
Swenson said he understands Shah ''wanting to 'tweak' his description of the events a little to make it a better story. But Shah's story goes beyond such editorial adjustments: The events described in his story never happened.''
The journal's editors said that Shah presented the essay as fact and that the editors thought it ''represented his actual experience.''
''I am so upset,'' said Dr. Catherine DeAngelis, JAMA editor. ''It breaks my heart when this kind of thing happens, and there's no reason for it.''
She said JAMA editors question essay authors when their stories sound suspicious, but the process isn't foolproof. ''What could we do short of giving them lie detector tests?'' she said.
Shah's essay isn't the first time the JAMA column has stirred controversy.
A 1988 piece in which an anonymous doctor described helping a dying cancer patient commit suicide prompted calls for prosecution of the author. The AMA wound up in court, where it successfully defended the right to protect the author's identity.
Dr. George Lundberg, then JAMA's editor, said he believed that essay was factual, though there were others during his tenure that were thought to have been embellished ''and sometimes even fabricated.''
Readers know that is the nature of essay prose, and ''in general, nobody really cared all that much,'' said Lundberg, editor in chief of medscape.com, an online medical information site.
Medical journal editors worry far more about publishing research that is suspected of fraud or fabrication, and do not have the budgets to check out every author of prose, he said.
Dr. Jeffrey Drazen, editor of the New England Journal of Medicine, said he has assumed that JAMA's ''A Piece of My Mind'' columns are factual. But he said he would not find it troubling if some were fabricated.
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