Some readers are probably aware that the Green Journal recently retracted a Neurology and the Humanities submission by Dr. William Campbell, titled Lucky and the Root Doctor. Dr. Campbell wrote about a former patient, a Southern Black man, who chose a traditional healer called a root doctor over his own ministrations for polymyositis. Had the article focused on this choice and educated readers about root doctors, perhaps with reference to the larger history of nineteenth century medicine, it might not have generated much controversy. But the piece contained characterizations of this patient, his family, and other Black people Dr. Campbell encountered during his time living and practicing in the South that many considered racist. For example, there is an extended discussion of the patient’s “nature” as a euphemism for his sexual function. His wife’s adiposity is described as having “jiggled when she giggled”. Another person is reported “individually salting each French fry”.
The episode is regrettable beyond the racial stereotyping. As someone who has helped select the AAN’s Creative Expression Award recipient for the last few years, I’ll offer that the piece does not, as required by the award for which several of Dr. Campbell’s other submissions have been considered, “artistically express human values in the practice of neurology, including compassion for persons with neurological disorders and reflection by physicians involved in their care.” Rather, this piece arguably takes on a judgmental and not a compassionate tone, especially with respect to diet and obesity.
Take care of all your memories, said MickBob Dylan
For you cannot relive them
And remember when you’re out there
Tryin’ to heal the sick
That you must always first forgive them
Certainly, unhealthful dietary patterns, metabolic syndrome, and the resulting diseases are major public health problems, especially in the South. But there are good arguments that these stem as much from social and political factors as from personal failings. As Dr. Robert Lustig puts it, are we to blame rising obesity among 6 month-old infants on their gluttony and sloth? People suffering from these diseases, like all patients, deserve compassion and not ridicule.
In response, Neurology has not only removed the article from its website, but also invoked its copyrights to force Medscape to delete a PDF linkage. They’ve suspended the Neurology and the Humanities section of the Journal and
fired accepted the resignation of its editor, Dr. Anne W. McCammon. The AAN’s website describes a number of other steps being taken to improve their editorial and other processes as regards equity, diversity, and inclusion.
I don’t doubt the sincerity of the Neurology or AAN leadership; they seem truly saddened that our flagship publication carried an article so insulting to so many readers. However, I don’t fully agree with their responses. The copyright-enforced disappearance of the article seems akin to a book burning. We’re all adults here–we can read something controversial and even insulting and potentially benefit from the ensuing discussion. On the Synapse listserv (login required) there were people who genuinely asked to be educated about what made this piece so objectionable. Others responded eloquently about lingering racial caricatures such as that of the jolly mammy. A notice of retraction that thoughtfully critiqued this article might have done more to help extinguish such caricatures and improve our future discourse than simply expressing outrage, guilt, and renewed, but also somewhat platitudinous, expressions of commitment to diversity, equity, and inclusion.
Similarly, a thorough analysis of the piece and the editorial process that led to its publication would make Dr. McCammon a better editor. Neurology and its readership would then benefit from the ongoing efforts of someone with 8 years’ experience in the role, now much wiser after having been held accountable for this poor editorial decision.
Finally, I suggest that Dr. Campbell himself also deserves some compassion. I don’t know him personally, but do know that he’s a veteran and a long-time contributor to our field. He’s authored many papers, as well as the most recent edition of DeJong’s classic, The Neurologic Examination. He’s contributed several other, non-controversial, pieces to Neurology and the Humanities. He maintains a Wikipedia-like website of neurological signs that I think is a nice resource for learners. Medscape quoted him thus: “The retracted article described an encounter with a memorable patient that reached across the generational and ethnic divide. It is a work of creative nonfiction that describes real people and real events in a literary way. Some took offense. Certainly, none was intended.” Of course, that no offense was intended doesn’t mean that the piece wasn’t offensive, and I agree that it did not merit publication. But since it was nevertheless published, constructive responses to the article would have helped make Dr. Campbell, and perhaps other authors, into better writers.*
In comparison to these responses to Neurology’s poor editorial decision, consider how we respond to poor clinical decisions. We all make those from time to time, but assuming no malice or pervasive pattern of error, we learn from the experience; we are not banished. And if the errant physician is a resident, his or her program director is not summarily fired. In my own program, we’ve even renamed M&M to “Systems of Care” conference specifically to distance ourselves from the old-school practice of berating (but even then, generally not firing) individuals for their mistakes. We’re all ignorant about something (most things, really, thinking about the universe). It would be regrettable if, whenever people make errors of ignorance, they are banished from the arena and thus unable to make future contributions of value.
*Update #1: A relative retorted to me that those who have been subjected to historical and ongoing stereotyping and discrimination are under no obligation to educate others on these matters. Fair enough. My constructive criticism here is not of the individual readers who voiced their offense to the piece, but of the AAN’s response as an organization whose vision is to be “indispensable to its members”. The point is that our membership would benefit from a more thoughtful and, yes, educational response.
Update #2: The most common further criticism I’ve received on this commentary is that it seems I’m arrogating to myself the right to “forgive” Dr. Campbell for offending people. I didn’t mean it this way, but can see the concern. My argument is not that he should “get a pass because he’s a good guy”. It’s that we should approach a problem like this with the aim of educating people (author and readers alike) about what made it offensive to so many other readers. In this way, we gain insight into our previously unexamined beliefs and biases and thereby become better doctors, better writers, and better people. I really intend for this to be a positive message and regret not making that as clear at it could have been.