Karl-Henrik Grinnemo was worried. The doctor and clinical researcher at the Karolinska Institute was working with a high-profile surgeon who was performing a potentially life-saving procedure on patients, but Grinnemo saw that the patients weren’t doing very well. So in 2013, Grinnemo and three other doctors raised concerns about the work of Paolo Macchiarini. The surgeon initially fought back, and accused Grinnemo of misconduct. KI sided with the star surgeon, and found Grinnemo guilty of “carelessness” in a grant application to the Swedish Research Council, including plagiarism. Readers should by now know how the story ends – Macchiarini’s work has since been largely discredited. Recently, to clear his name, Grinnemo asked authorities to take a second look at his case – and he has been exonerated. We talked to him about the last few tumultuous years.
Retraction Watch: How does the story begin?
Karl-Henrik Grinnemo: In 2013, myself and some colleagues began raising concerns about the work of Paolo Macchiarini. We saw that patients who received an artificial trachea weren’t faring well after the procedure, so we started to investigate if there were animal studies or other data to support that the grafts work in patients. But as soon as we started to ask questions of Paolo Macchiarini, his team began to act strangely. We filed a complaint to get Macchiarini to stop doing the operations, because they were dangerous, and patients were really suffering.
RW: How did Macchiarini respond to your complaint?
KG: In April 2014, Macchiarini filed a complaint against me, alleging I had stolen his work in a grant application. His real goal, of course, was to miscredit me as a scientist and collaborator. We had written several applications together, as collaborators and co-investigators. As per normal practice, I reused one of the applications in a grant to the Swedish Research Council. We owned the data together – he was allowed to use it, as well, if he wanted to do an application. I would have had no problem with that. Even though my team had done all the research, generated the data, and written the applications. But when I submitted something without him, Macchiarini accused me of coopting the applications for myself. One year later, the former vice-chancellor of KI, Anders Hamsten, ruled that I was guilty of “carelessness.”
RW: How did you feel when you heard the verdict?
KG: I was really upset. The grant I submitted was in my field of creating new heart valves– Macchiarini didn’t even work in that area. I felt like KI wanted to discredit me and the other whistleblowers, because in 2014, Macchiarini was still doing well. He was about to receive a big grant, and he was bringing a lot of prestige to the institution. For them, it was easier to get rid of me.
Because I had raised concerns about such a popular figure at KI, I had already been shut out of a lot of research networks at the institution. But the 2015 verdict made it worse. Despite my publication record, I didn’t receive any new grants. No one wanted to collaborate with me. We were doing good research, but it didn’t matter. We were “marked” by the vice-chancellor’s verdict. It was a terrible time. I thought I was going to lose my lab, my staff – everything. It’s been three tough years.
RW: What changed?
In the beginning of 2016, Swedish Television aired a series of documentaries that raised new concerns about Macchiarini’s work. That changed everything. KI ordered a new investigation, Macchiarini was dismissed, and the vice chancellor resigned. The new vice chancellor, Karin Dahlman-Wright, sent my case for review to the Central Ethical Review Board’s (CEPN) expert panel for scientific misconduct. I included the exact same evidence as before. In December 2016, they ruled that what I had done was usual practice for the research group, who had been using the group’s data in various grant applications. Dahlman-Wright agreed, and this week KI issued a statement that cleared me of previous suspicions, including plagiarism.
The announcement has made a huge difference already. I’m getting collaborations, working for the Swedish Research Council evaluating grants for them, and I feel I’m back in business. I’m hoping I can now compete on the same grounds as anyone else for research grants.
RW: Although your allegations weren’t initially taken seriously, over the last couple of years you’ve watched Macchiarini’s star fade, and KI take some blame for how it’s handled this episode. How has that felt?
KG: There’s no simple answer to that question. We filed the complaint to stop the dangerous operations. We were not against KI and the hospital. But the way they handled the situation was a form of misconduct, in a way. They didn’t listen to our warnings. Macchiarini continued with his work. Without the documentary, it would never have been possible to stop him. I’m really happy today knowing that he’s not performing any more operations in Europe and the United States. From this point of view, I’m relieved.
And I’m relieved we could change the leadership of KI, so it’s more open to these kinds of warnings. For years at KI there was a culture where only the top researchers were supported, and the leadership wasn’t open to criticism against these top players and what they were doing. There was so much prestige related to the recruitments. I’m relieved now that we’ve changed the leadership, I hope it will build up a more open culture that won’t experience anything similar in the future.
But I’m still eager to see Macchiarini’s articles retracted. Last year, I removed my name from one of his major papers, a 2011 study in The Lancet that served as a proof-of-concept for his surgery. That paper – which is still being cited – should be retracted, because of the misleading clinical picture it paints of the patient who received the artificial trachea.
My colleagues and I are investigating all the biopsies he collected for that paper, and demonstrating how they are not correct. We’re planning to publish a follow-up paper showing what really happened with this patient, and how Macchiarini was able to convince readers his grafts worked, when they really didn’t. It should serve as a warning about going too early into patients with an unproven technology.
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Enormous respect for Karl-Henrik Grinnemo who raised concerns about the work of Paolo Macchiarini and protected the life of patients.
I completely agree!
I wonder if the patient mentioned in this post ever saw what was written about him/her (I have not read the paper). Would they have been able to see that the information was misleading?
I have been asked in some IRB applications how I am going to let the patients know about the overall results of the study. It seems like the patients should get these.
Karl, I salute you for standing up for the integrity of science, and most importantly, for the patients, who apparently were treated as “experimental animals” without proper ethics protocol. At my university, in order to perform even a simple, non invasive study, on laboratory animals, researchers must submit a 15 page form/protocol with detailed justification for use of live animals. Such protocol would have go, first through the peer review process, and then be scrutinised by the animal ethics committee.
I salute the current management of Karolinska for taking responsibility for the sins of former management, and doing the right thing to correct the wrong, which vindicated Karl and his colleagues. Sadly, the fact remains that such reprehensible actions of KI former vice-chancellor, Mr. Anders Hamsten, left a black mark for eternity on the reputation of an otherwise well respected institute.
This, in all fact, is not over. KI still needs its own enema to determine how the original conclusions/decisions under the previous vice-chancellor (et al.) came to be against Grinnemo. Then we need to read about it and how KI will attempt to ensure this does not happen again, otherwise this will most likely happen again.
I tend to agree with the general thrust of the suggestion, but it seems to me that their problems, as they relate to scientific publishing, have more to do with diarrhea than constipation. But I’m not in medicine.
Good story to teach Ethics in research to our students!
First: Great job Karl-Henrik!
I wish there were a lot more of these stories from the non-fraudulent side of the papers around. Not the whistleblowers (although the generic media narrative strongly favours those), but the story of co-authors that were as scammed as the rest of the world.
But there is a question in this that still baffles me and which I think is strongly relevant to the KI “enema” proposed elsewhere in this thread. The Lancet paper which is referred to was published in 2011 and studied a patient who had been treated some time before that. As has become clear later, he was not at all well even at the time of publication (this fact is what constitutes the primary fraud allegation).
Now, how can it be that the co-authors do not start raising concerns until 2013? Where there really no other problems anywhere else along the way?
The study introduces a completely untested and and un-understood procedure. Why on earth would anyone (co-author or not) believe that it works at all? I mean, why the wishful thinking?
The proper attitude when faced with fantastic claims – and the co-authors in this case certainly should have been aware that they were fantastic – is one of deep scepticism. It is to say “Hey, this sounds too good to be true, we must have missed something. Can I have another look at the records?”. The most important question for KI to address (once all the responsible heads have rolled) is how they became a place that does not cultivate this proper critical attitude.
Sorry for raining on the parade while the whistleblower ticker tape is still falling, but any fix of the fraud problem also involves discussing the fact that every fraud or error discovered post-publication is also a failure of the co-authors to spot it PRE-publication.