For the past 14 years, a cardiac surgeon in Italy has been trying to blow the whistle on a study written by his former colleagues that has been the subject of several investigations – with two of them finding problems with the data. And despite defeating three defamation lawsuits, two which were brought by authors of the paper, he’s not giving up yet.
The 2006 paper, ‘Relationship between atrial histopathology and atrial fibrillation after coronary bypass surgery’, written by several of cardiac surgeon Vittorio Mantovani’s colleagues at the Ospedale di Circolo in Varese, was published in the Journal of Thoracic and Cardiovascular Surgery. To date, the paper – which has been cited 57 times, according to Clarivate’s Web of Science – has been investigated by at least two institutions as well as the journal. None have resulted in a retraction, despite one university finding that only a little more than half of the patients in the dataset could be matched unambiguously with biopsy samples. One university is also waiting on the journal to act before it considers reopening its own investigation.
For Mantovani, the red flags started appearing in 2010, when he came across a minor discrepancy between two other papers written by him and his colleagues. He thought it was odd that in one dataset, patients were identified by name, but in the other, they were identified using numbers.
Mantovani asked Giuseppe Cozzi, an author of the 2006 paper and first author of both of the other papers, for a list of the patients’ names. He received no reply, and Cozzi has not responded to our request for comment on this story.
Mantovani says Cozzi not answering a “simple question” led to him losing confidence in his colleagues and their published work. He made efforts to have the 2006 paper investigated by the institutions involved.
The findings of the first institutional investigation into the paper came from Umeå University in 2012 – where lead author of the paper, Giovanni Mariscalco, had completed the study as part of his PhD thesis. Their report, written in Swedish and Italian, found several inconsistencies in the dataset, but ultimately concluded that there were no reasons to suspect scientific dishonesty.
Things had taken a turn for the worse in the Varese hospital once Mantovani voiced his skepticism of his colleagues’ published work. In a complaint to police, he accused his colleagues of workplace harassment. They were cleared of the charges.
Mantovani was also sued for defamation by two of the paper’s authors — Mariscalco and Andrea Sala, plus a third from Cesare Beghi, the head of cardiac surgery at Varese hospital. He won all three cases. Beghi has not responded to requests for comment, and Sala could not be reached for comment.
“Being honest is expensive,” Mantovani said. “But what is the alternative?”
Part of Umeå’s investigation relied on the hospital in Varese verifying the authenticity of the data. In response to questions from the university, Cesare Beghi, the head of cardiac surgery at the hospital, wrote two letters verifying that the data was accurate, and effectively put an end to the investigation.
Because of the police involvement in the previous allegations at the hospital, they had been wiretapping conversations among the staff. Police wiretaps from November 2012 – which the University of Insubria would later include in an appendix to an investigation report – revealed that the letters Beghi wrote were drafted with Mariscalco, the lead author of the 2006 paper and one of the subjects of Umeå’s inquiry.
Then, in September 2017, the University of Insubria – the home institution for several of the paper’s authors – published the results of its own investigation into the paper. It found that the paper was not randomized as it had claimed, that only 41 patients out of the 70 could be matched unambiguously with each biopsy slide, and that eight patients were enrolled before the approval of the ethics committee.
According to the final report of the investigation, Mariscalco told the investigators he had requested the folders with the collected data from the hospital, but the folders were found empty. Sala, one of the coauthors, told the committee that the patients were not randomized to protect their health. The report concluded that the committee had “doubts as to the collection of the data and the complete correctness of the research analysis.”
In an email to Retraction Watch, Mariscalco wrote that he was neither the principal investigator nor the one responsible for data histological storage, documentation or analysis. “I must point out that the overarching evidence around the study and its conclusions have never been questioned by the several investigations that have taken place,” he wrote.
He adds: “Despite some discrepancy across different datasets have been raised, these were largely anticipated in view of the temporal gap (more than 15 years) between the period when the study was conducted and the time when the clarifications were requested.”
In October 2017, Insubria sent the translated copy of its findings to Umeå University and then-editor of the Journal of Thoracic and Cardiovascular Surgery, Richard D. Weisel, who declined to comment for this story. The journal has not taken any visible action on the paper.
Umeå University revisited the issue in 2018 and according to a letter (in Swedish) written by the University’s legal representative, Chatarina Larson, and Patrik Danielson, the dean of the faculty of medicine, they decided not to act on the findings of Insubria’s investigation. They wrote that if the Journal of Thoracic and Cardiovascular Surgery took action against the article, Umeå University would have reason to review the case.
In an email to Retraction Watch, Larson explained:
…in Swedish Administrative Law (1985:223) (today Swedish Administrative Law (2017:900)); A Swedish authority may change a decision it has pronounced if it is incorrect. But regardless of such incorrectness it is not allowed to change such a decision if the decision by its nature is favorable to any individual party. In such case it must not be changed to that individual´s disadvantage, unless the inaccuracy is due to the party having provided incorrect or misleading information…
Umeå University is an administrative authority of the state of Sweden and obliged to comply with Swedish law. According to the clause of the Swedish Administrative law referred to above Umeå University was not allowed to reconsider the matter from 2012 unless its former decision was found to be incorrect – and if so – the incorrect decision was based upon incorrect or misleading information deliberately provided by the party.
Umeå University’s decision from 2012 was a decision by its nature favorable to the party concern. The Italian report did not draw any conclusions in the matter of whether the data inconsistencies were intentional or negligent. Thus, there were no circumstances that showed that Umeå University’s decision in that regard was incorrect.
In other words there was no legal possibilities, or obligations, for the university to reconsider its earlier decision in this situation.
According to Danielson, Umeå University contacted the journal to ask whether they would take action based on the findings of the investigation and received no response. Mantovani himself has contacted the journal several times to follow up on whether they would be taking action on the paper, and says he has received no reply.
In an email to Retraction Watch, the current editor-in-chief of the Journal of Thoracic and Cardiovascular Surgery, G. Alexander Patterson, wrote that he hadn’t been aware of the issue until our email in January and consulted the previous editor.
He said that the journal’s ethics committee did an internal investigation “with appropriate due diligence”, and decided not to retract. “I understand that the matter was also before the Italian courts,” he wrote. “We are not aware of their deliberations or decisions.”
There is no indication of the internal or external investigations into the paper on the journal’s website. “Maybe they have a good reason not to retract the paper or not to put a notice of warning,” Mantovani says. “The rest of the scientific world should know that.”
In his response to our questions, Mariscalco wrote that the paper had been subject to several investigations, including a UK investigation he declined to share, which “cleared me from any allegations, including research misconduct.” He then threatened to sue if we published a story about this:
Given those evidence, and given the long list of attacks around the same matters I have been subjected over the years, I will consider harassment and defamation any article that reports these incredibly old allegations without giving great relevance to the conclusions of all the following investigations that have cleared my name from any allegations/charges. Please be advised that I could pursue legal actions to the appropriate Authorities to protect my reputation, and this may include seeking damages for the harm caused.
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