“Misconduct” leads to retraction from Italian “super surgeon” under house arrest

Has the Annals of Thoracic Surgery had a change of heart? Evidently the publication that told us nearly two years ago, in effect, that the reasons for retractions in its pages were “none of [our] damn business” has decided that information is worth sharing after all.

The ATS has retracted a paper it published in October. The article, titled “Development and Validation of a New Outcome Score in Subglottic Stenosis,” came from a group of researchers in Florence, Italy.

As the notice explains:

This article has been retracted at the request of the Editor-in-Chief.

Reason: This article has been retracted for scientific misconduct for reproducing a table but failing to acknowledge and cite the previous, original work from which it was taken: Nouraei SAR, Nouraei SM, Upile T, Howard DJ and Sandhu GS. A proposed system for documenting the functional outcome of adult laryngotracheal stenosis. Clinical Otolaryngology 2007;32:407–409, http://dx.doi.org/10.1111/j.1749-4486.2007.01474.x.

We congratulate the journal on its straightforward handling of this case.

What the notice doesn’t say is that the senior author of the offending paper, Paolo Macchiarini, is a major figure in the world of thoracic surgery and regenerative medicine. Macchiarini, whom the Italian press calls a “superchirurgo” — super surgeon is credited with having performed pioneering work on trachea transplants in both adults and children.

And the notice, perhaps understandably, also fails to say that Macchiarini reportedly is under house arrest in Italy, where officials have accused him of fraud and attempted extortion.

28 thoughts on ““Misconduct” leads to retraction from Italian “super surgeon” under house arrest”

  1. Interesting. They are charged with reporting articles on public health issues, but when questioned by the public, they claim its none of the public’s business. I guess they think we should swollow whatever garbage they dish out. Its not just the Europeans
    JAMA is the same way.

  2. I don’t know why I’m jumping in on this, but every once in a while the old defense lawyer reflexes cut in.

    The “fraud and extortion” with which Dr. Macchiarini is charged, if I understand it correctly, refers mostly to actions which would be entirely legal in the United States or Britain. In essence, he agreed to arrange medical treatment at private clinics outside Italy for patients with advanced cancers who would not be eligible for treatment under the Italian system. In at least one case, he negotiated a (large, but not unreasonable) fee for his own services as part of the deal.

    Bear in mind that the doctor has made a career out of performing surgeries on otherwise terminally ill cancer patients and has, for example, established a charity to fund just this kind of operation. Aggressive surgery on terminal cancer patients is not favored in systems with strictly rationed health care, so it is not surprising that his reported breakthrough operations seem to have been done outside Italy or that he would arrange for such surgeries to be performed in private clinics out of the country.

    In essence, the claims amount to (a) conspiracy to line-jump his patients and (b) moonlighting on his job as medical director. This is apparently considered fraud and extortion under Italian law — and I suppose it is, when looked at from the unique perspective of an Italian prosecutor. However, as we learned in the Aquila earthquake matter, Italian legal concepts don’t translate well, much less literally, into English.

    And “senior author”? In the sense that Dr. Macchiarini’s name came last, yes. However, unless there’s a pattern of poor supervision, the physician in charge typically shouldn’t be held responsible for someone else’s plagiarism. That’s particularly true when the man has been under “house arrest.” Perhaps he should not have been on the paper at all; but, as medical director, his name may well have been required in order to get permission to publish. Actually, one might advance the paranoid hypothesis that this remarkable change of heart (so to speak) by ATS may have something to do with an ambitious investigating magistrate assuring the editor of immunity in an attempt to degrade the reputation of a well-regarded physician.

    No, I’m not serious about that part. I’m simply making a speculative case for the defense here. The serious point is that, for all we know, Dr. Macchiarini is a complete saint. Actually, this will probably turn out to be a morally undramatic story: aggressive, ambitious prosecutor vs. aggressive, ambitious doctor, with neither one having ethical qualities much different from the average.

    1. “And “senior author”? In the sense that Dr. Macchiarini’s name came last, yes. However, unless there’s a pattern of poor supervision, the physician in charge typically shouldn’t be held responsible for someone else’s plagiarism.”

      The senior author is ALWAYS responsible for the content of a publication…without question. If Dr. Macchiarini did not have the time to properly fulfill his role as senior author, he should have passed the manuscript to someone else.

      As for the charges, who knows? It is Italy after all.

      As for the retraction, where there any repercussions on the good Dr.? Or did things go back to business as usual. Those Hanover folks sure seem untouchable.

    2. What exactly do you know about this case? Are you award that Macchiarini was lying to his clients about month-long waiting periods for surgery when in fact it was a few days, to be able to charge them 150,000 euros rather than have it done free of charge in Italy? I am an attorney, and I would never make such brazen comments without first knowing the facts.

  3. An otherwise routine case of plagiarism is morphed into an obscure, subtle intrigue between aggressive surgeon, aggressive prosecutor, and Italian patients with a lot of money but statistically very little life (and having money makes you want to beat the odds, always) against a rigid rationing system (like it or not, this is what we are going to be forced to do also.)
    It is possible that, if we were to ask the senior author, he might tell us that he never got to see the paper before it was published. So he may not be responsible for the plagiarism (or the paper as a whole) due to circumstances.
    I’m curious as to why the Italian system doesn’t allow people with a lot of money to throw it away on aggressive surgery for terminal cancers. Surely there is some societal good to be gained from torturing dying patients with their consent in ever more technically complex and expensive ways?

    1. “I’m curious as to why the Italian system doesn’t allow people with a lot of money to throw it away on aggressive surgery for terminal cancers.”

      I don’t think it does prevent them, rationing (to the extent it exists) is for the public health sector, Toby White is just getting a little carried away in his role as pro-bono defense attorney. If you want to use the free-market, provided you can find a surgeon, you can do what you want.
      Actually, when it comes to rationing, I expect private health insurance firms would be as rigorous rationers as anyone.

      1. Thanks for the helpful link, LGR. I think the problem in Dr. Macchiarini’s case is not the legality of patient payment, but the legality of a physician recommending such treatment, and perhaps accepting a fee for the treatment. Dr. Macchiarini is an employee of what appears to be a public hospital, and the treatment is “not medically necessary” or is “investigational” (to use roughly equivalent U.S. insurance parlance). So, from the prosecutor’s point of view, the doc can be made to look like a greedy quack trying to make a private buck on company time. Of course, he can also be made to look like a dedicated medical visionary with unique skills, trying to escape the bureaucratic restrictions which are killing his patients. Deciding which picture is more correct is left as an exercise for the reader.

        @conradseitz, you are entirely correct. This is a routine case of plagiarism, probably having little or nothing to do with Dr. Macchiarini. To be completely honest, I thought that a report of this incident implying some major character flaw in the doc, by gratuitous mention of an unexplained, unrelated (and unadjudicated) “fraud” charge, was a bit unfair — hence my reflexive charge against the windmill.

      2. Toby White, the background on stories and people that RW provides is a useful part of the blog. Otherwise, the notices would include nothing more than what is provided by the journals. A statement by the Italian authorities that the doctor is accused of fraud is not god’s last word on the subject. It is an interesting additional aspect. I am glad that readers have information to add concerning the possible nature of the fraud and the ins and outs of Italian health care policies. We all become more informed as a result.

        I agree with other commenters: if the doctor is so busy or so removed from the process of writing the manuscript that he does not recognize a table that his fellow authors did not develop themselves but rather reproduced without permission or credit, then he should not be an author. If he is an author, then he must take some of the blame for plagiarism and copyright infringement.

    1. No question that these cases make people who did not succeed in science (if you blog a lot and are into the blog popularity context it is certain you belong to that category) better about themselves: I may have not made it, but at least I did not do anything fishy.

  4. As an Italian physician, in good relationship with prof. Macchiarini, and who sent him some patients for surgery, I can add some additional information about his problems with Italian law. Actually, he is no more under arrest (he was released in early October). He was accused of asking 150.000 euros to arrange a cure in a privat clinic in Germany for a patient with lung cancer and brain metastases; the wife produced a record of a meeting with prof. Macchiarini to the public attorney where- as reported by teh public attorney to the journals- he was asking this money. After this accusation all the italian patients who had been operated by him in the previous two years were asked if they had to pay prof. Macchiarini for the surgery. Actually, most of them did not pay anything. Some, requiring non urgent surgery, could simply choose if enter in the waiting list (based on clinical needs: urgent surgery first) of the public hospital in Florence where prof. Macchiarini worked part-time (he is also professor at Karolinska in Stockholm), or to be operated paying a fee as privat practice, outside the duty on the public hospital, earlier. I can testify that patients in need of emergency surgery were operated within few days, completely free of charge. No one of the patients interviewed had any complaint against prof. Macchiarini. When Macchiarini’s lawyers and the judge in charge of examining the proofs of the public attorney had the opportunity to hear the INTEGRAL version of the record provided from the wife of the first patient (the only one who accused him) it was clear that he had just explained that thoracic surgery in a patient with brain metastases was meaningless, and that he could have considered surgery only after successful naurosurgery. He suggested to ask a consult in 4 italian hospitals and concluded “If you don’t find a nurosurgeon in Italy, I know a very good clinic in Hannover, but it’s privat and may cost up to 150.000 euros”.
    As regards the fraud, the first author is responsible; probably the senior author read the paper and checked the data and the text, but did not realize that the table was not original. According to ISI Web of Science, the H Index of prof. Macchiarini is 30, so I don’t think that he desperately needs one more paper in his bag.

    1. “According to ISI Web of Science, the H Index of prof. Macchiarini is 30, so I don’t think that he desperately needs one more paper in his bag.”

      The second part does not follow from the first part.

      1. In my opinion, the second part logically follows from the first. If you have already published more than 160 artcles (including several ones on Lancet and other major journals), would one more paper (on a minor topic) on Ann Thorac. Surg change your scientific reputation or your H index?
        Second question: if the plagiarism was so evident, why the peer reviewers did not notice it?
        Third question: if the only plagiarism was to insert a table (the very same or a modified one? It is impossible now to read the article) without quoting the original work, maybe the Editor could have required just to publish an “Errata corrige” where the Authors apologize for the mistake. Or replace the retracted article with a new version including complete quotations. This would have been helpful for the “plagiarized” Authors, who could have one more quotation.

    2. I agree with Chiara’s interpretation of the facts around the retraction. I am surprised how quickly a judgment may be done over a misconduct, as long as the offender is on the public opinion highlight. I also perceive as hard that Macchiarini intentionally omitted that citation. I believe he didn’t double check the references.
      I am happy that a scientific misconduct has been rapidly spotted and fixed, but I expect the very same treatment to any other publication. Which it doesn’t happen, according to what I read by other posts on RW.

      1. Blogs and any media outlets survive depending on hits, right? If someone famous does something fishy many people will tune in. If it’s a nobody, well, nobody cares. So, is it that surprising?

      2. “Blogs and any media outlets survive depending on hits, right?”
        Not really, a wordpress blog is absolutely free. I dare say Marcus and Oransky gaze fondly on their stats, but the blog’s survival is not contingent on the number of hits, depends only on their interest on putting up material.

    3. It is quite interesting to read Chiara’s justification of Dr. M’s actions in light of all the developments.

  5. Wow, it sounds like Italian senior authors do not feel like they hold any responsibility for the correctness of a publication. A rather frightening fact that I need to keep in mind.

    1. IMPORTANT: My supervisor DO control citations. I wrote that sentence to highlight the responsibility of citation to first authors rather then last, but I clearly put it down wrong.

  6. Reading the text on the JPG file put up on SciencePlug blog page, under “Materials and Methods / Creating TECs” it reads “…Item content for the TECS was derived from the input of thoracic surgeons, otorhinolaryngologists, bronchologists and physical therapists who are involved in the care of patients with laryngotrachel disorders…” I may be misinterpreting but it doesn’t read like a bibliographic omission.

    1. I’ve finally found and read the retracted paper.
      Actually, there was some plagiarism, because the words in table 1 are EXACTLY the same of original table. Nevertheless, In Gonfiotti/Macchiarini works the table differs in eliminating one of the items (“Airways status”).
      If I were the first author, I would have quoted the original paper (which was actually just a letter proposing a grading system) in the Table adding “modified from…”. It would have been very simple, and I don’t know why it was not done.
      But the core of the paper (the integration of the clinical score with an endoscopic score, the equation to calculate the score, and the validation of the method ) is original.

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