Meet the filmmakers who cracked open the case against star surgeon Macchiarini

Paolo Macchiarini — once a world-renowned surgeon for creating tracheas from cadavers and patients’ own stem cells – has been dogged for years by accusations of misconduct. Officials at his institution, Karolinska Institute, initially cleared him of many charges, but that all changed earlier this year, when Swedish Television (SVT) aired a series of documentaries about Macchiarini and his work. The series alleged, in part, that he operated on patients in Russia whose conditions were not life-threatening enough to warrant such a risky procedure. Such serious accusations caused a media storm, and prompted officials to take a second look at Macchiarini’s work. KI dismissed Macchiarini, and many others have resigned, including KI’s vice chancellor. Recently, two new reports critiqued KI’s role in the case, and Sweden’s Central Ethical Review Board found Macchiarini guilty of misconduct in a 2014 paper. We spoke with SVT producers Bosse Lindquist and Johannes Hallbom via email about the fallout from their series.

Retraction Watch: Your documentary series has caused quite a storm: A series of resignations and renewed investigations have followed. Are you surprised by the reaction?

Bosse Lindquist and Johannes Hallbom: In one way, we were a bit surprised that the documentary would cause this kind of enormous reaction; in another way, we knew that this had the potential to get really big. When we had read the original accusations regarding scientific misconduct against Macchiarini, and had reviewed the replies by both the external reviewer (Bengt Gerdin) and by Macchiarini and his colleagues, we felt pretty certain that Macchiarini was indeed guilty of scientific misconduct. We saw nothing in the arguments made by Macchiarini and his co-authors that changed our minds. When the vice-chancellor of KI then surprised us by exonerating Macchiarini from all accusations we knew the stakes had increased.

If we were right about how humans had been used as guinea pigs and that the science was partly false, then this story had the potential to blow up. Of course, if we were wrong, or failed in our work, we might face serious repercussions from challenging such powerful players within the medical establishment. As we then dug even deeper into the case we soon realized that not only were there a series of problems with Macchiarini’s work, but also that KI was trying to cover it up. Seeing as how the story revolved around questions of life and death, the respect and value of human life at the forefront of scientific research, and took place at the prestigious KI (home of the Nobel Prize) – we knew that it had potential to gain a lot of attention. Then again, everything that has happened since we first aired the series (and what keeps happening) is clearly more than we could ever have hoped for.

RW: What, in your opinion, were the most worrisome revelations of the series? What do you think should be done about them?

BL and JH: First of all, the fact that Macchiarini had used human beings in difficult circumstances to try out his synthetic tracheas by literally deceiving them that this was their only option to survive, and without prior animal testing, is troubling enough. The fact that he had deliberately neglected ethical rules and had lied in his scientific articles about the outcome of his operations, is another extremely worrisome revelation. That KI and Karolinska Hospital had been warned on several occasions about Macchiarini and had tried to quiet those who tried to raise the alarm (eg, the four whistleblowing doctors) is very disturbing. KI and the Hospital need to take full responsibility for their actions. They should apologize to the whistleblowers for the treatment of them, compensate the families of the patients, and acknowledge their role in what happened with Macchiarini’s work in Russia. Most importantly, they must — as soon as possible — conclude their renewed inquiry into Macchiarini’s possible scientific misconduct and falsification of patient data. The scientific record must be set straight by and this and will probably entail having a number of Macchiarini’s papers retracted.

RW: Does the fallout from your documentary series — as well as the profile in Vanity Fair about a web of lies Macchiarini told a producer at NBC News — say anything to you about the power of journalism?

BL and JH: Investigative journalism can be a powerful tool for change, but it needs time and money. The real power here was knowledge. The fact that we had access to Macchiarini and his work, as well as his patients and collaborators, gave us a chance to understand in depth the science as well as the clinical work. We also had a strong editorial team who worked long hours to really try to comprehend the complex world of regenerative medicine, stem cell research, nanotechnology etc., so we could actually evaluate what had really happened. Adding to that, we made sure to find and hear what the families of the patients had to say, and in the end had a much better overview than perhaps even Macchiarini himself. We do think investigative journalism has an important place in society, not the least as a watchdog when democratic pillars (like academia and medicine) fail to do their job.

RW: Just recently, two new investigations found some fault with the Karolinska Institutet and the Karolinska University Hospital. What do you think about these investigations, and their conclusions?

BL and JH: Basically, the reports confirm the findings of the documentary series. The reports do a good job of detailing the administrative mechanisms that made these disastrous plastic trachea operations possible. They also hit at the sorry lack of internal criticism among staff at the Karolinska University Hospital and KI. They added more knowledge to the shockingly poor process of the recruitment of Macchiarini to the Karolinska. We could not have imagined that there were so many warnings from previous employers of Macchiarini (universities and hospitals) to the Karolinska not to employ Macchiarini – all of which were ignored.

On the other side, the inquiries failed to expose Karolinska’s responsibility for the horrific operations performed in Russia. The Russian trials on patients who only suffered from benign conditions would never have happened without Karolinska’s stamp of approval on Macchiarini’s science. Also, Karolinska failed to warn the international community when it was clear that the surgeries had failed and the plastic method was not only dangerous but lethal. Still, Karolinska has not acted to have the papers in Lancet, Nature Communications and elsewhere retracted.

Finally, so far there has been no investigation into how the hospital and the institute could not only ignore the very early warnings from the four senior physicians who sounded the alarm early 2014, but instead threatened and punished them in numerous ways to make them shut up.

RW: You spent a lot of time with Macchiarini as a result of the filming. What were your impressions of him?

BL and JH: He is quite charismatic and can be very likable, fun and intellectually provocative. When critically questioned, a less charming side may however become evident.

RW: Anything else you’d like to add?

BL and JH: Macchiarni has pointed out that he was never alone in making the decisions that led to such fatal outcomes for a number of patients. He is quite right and has unfairly been singled out as the sole responsible person for the fatal surgeries and false science. Obviously, there were many more physicians and scientists involved in his experiments and his scientific reporting.

A number of senior officials at KI have now resigned or had to resign, which is good. A similar development would be welcome at the Karolinska University Hospital – it was after all there where patients died, not at the Institute. Still, his scientific papers have not been retracted from the Lancet and the rest of the papers where they were published. Several of them definitely should be – the scientific record needs to be cleaned up!

Note: Click here for a timeline of the most recent events in the Macchiarini case.

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