How the Karolinska protected Paolo Macchiarini — and whistleblowers paid the price

Carl Elliott

Retraction Watch readers may recall the story of Paolo Macchiarini, about whom we first wrote in 2012 before he became the subject of international scrutiny — and who has now been sentenced to prison. We are pleased to present an excerpt about the Macchiarini case from The Occasional Human Sacrifice: Medical Experimentation and the Price of Saying No by Carl Elliott published by W. W. Norton, May 2024.

One incident illustrates just how determined the leaders of the Karolinska Institute were to protect Paolo Macchiarini. In November of 2014, a leaked copy of the whistleblowers’ report came into the hands of the New York Times, which published an article titled “Leading Surgeon Is Accused of Misconduct in Experimental Transplant Operations.” The article detailed several of the most serious allegations against Macchiarini: that he had never obtained ethical permission to conduct his experiments, that his 2011 study in The Lancet had misrepresented the outcome of Beyene’s implant, and that of the three patients at the Karolinska Institute that Macchiarini had given synthetic implants, only Beyene had signed a consent form— and the form was dated two weeks after his surgery. The publicity generated by the article all but forced the Karolinska Institute to act. Anders Hamsten, the vice-chancellor, said he would ask for an external inquiry. 

Retaliation against the whistleblowers came quickly. According to Simonson, the whistleblowers were told that they had violated patient privacy and would be fired immediately. That didn’t happen, but in December the Karolinska Institute informed the whistleblowers that the head of the cardiothoracic clinic would deliver a formal warning, the last step before an employee is terminated.

The Karolinska Institute also reported the whistleblowers to the police. “I was called down to the police and put in a room with no windows, with a tape recorder and a lawyer and a policeman in front of me, and interrogated. That was pretty scary,” Matthias Corbascio, a cardiothoracic surgeons says. “It was exactly what it’s like on television. And you know, it’s hard to be a tough guy in that room.” 

The accusations were baseless; the whistleblowers had anonymized all the identities in their report, and Corbascio had applied in advance for ethical permission to access patient records. “I wrote that ethics application because I knew that they were going to try to fire us,” he says. 

In the spring of 2015, the external inquiry Hamsten had promised was completed. Dr. Bengt Gerdin, an emeritus professor at Uppsala University Hospital, concluded that Macchiarini was guilty of scientific misconduct. The inquiry didn’t address any potential abuses of human subjects, but the result of the inquiry was clear. Macchiarini had falsified his research. 

But even an external corroboration of misconduct didn’t deter the Karolinska Institute leaders. It took months for them to respond, and when they finally came to a conclusion, they called a press conference. “We asked if we could attend the press conference, and they said no,” Simonson says. “They then called our boss at the time and said that they were hiring guards to stop us from attending.” 

Accompanied by members of the Nobel Committee, Hamsten disavowed Gerdin’s external inquiry and proclaimed his confidence in Macchiarini. The whistleblowers were stunned. Macchiarini responded with gratitude. “To have been falsely accused of such serious misconduct is every researcher’s nightmare,” he said. The Lancet applauded the decision with an editorial titled “Paolo Macchiarini Is Not Guilty of Scientific Misconduct.”

Grinnemo remembers this entire period as a very dark time. The stress was overwhelming. “I mean, I couldn’t sleep. I was always thinking of this next strategic move,” he says. People he considered friends stopped returning his calls and emails. He could not concentrate on his research. He found it hard to give his children the attention they needed. “It was also hard doing surgery, to be standing there focusing on the operation,” he says. 

The thought that he might have sacrificed his career for a futile cause sent him into a panic. Corbascio felt the same way. The hostility at work was palpable. He says, “I think that Kalle and I were like the two most hated people at Karolinska, and I’ve no doubt about that.”

Carl Elliott teaches medical ethics at the University of Minnesota and the author of The Occasional Human Sacrifice: Medical Experimentation and the Price of Saying No, from which this post is excerpted.

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9 thoughts on “How the Karolinska protected Paolo Macchiarini — and whistleblowers paid the price”

  1. Regardless what one may think of his methods, it would be remiss not to mention the significant role played by Leonid Schneider in reporting on the Macchiarini case, including looping-in several of his collaborators who themselves have substantial appearances on PubPeer.

  2. The Lancet lost all credibility when they participated in the lab leak cover up. They deserve to go broke.

    1. The Lancet lost all credibility years ago, in my opinion, starting with their publication of the Wakefield study that did so much damage. And these are not the only two studies they’ve published and protected that should never have seen print. I don’t understand why The Lancet is still considered a prestigious journal.

  3. The ‘establishment ‘ scientific world stinks like rotting fish. Scrutiny is surely welcomed if your ethical trousers aren’t down by your ankles.

  4. As a peer review, I reported several cases of data fabrication to journal editors and, in one case, the editor said that he was not going to pursue a case because of a concern with possible litigation. I don’t understand why would a prestigious journal would want to cover up misconduct. Wakefield’s and Macchiarino’s cases clearly show that the cost to the journal is higher than if they had made the correct decision in the first pace. Worse yet, the cost to the general public is unacceptable.

  5. I’m just baffled as to why the leaders of prestigious institutions so consistently defend their scientists even with such clear evidence of misconduct. I don’t understand the psychology or politics at work. When it is clear that you have a researcher endangering people, how can you possibly think it’s going to work out better for your institution to pretend that’s not happening? What benefit were they hoping to get from defending him after an external inquiry already found him guilty? Wouldn’t it be better PR to immediately disavow him after such findings? Can someone explain what the motivation or thought process here might be?

    1. Easy. They are not only scientists; they likely serve as managers, hold important university positions, and are deeply involved in the organizational aspects of the institution. It is no longer a matter of the institution defending its researchers; it is now the researchers defending themselves under the institution’s name.

  6. Our extreme reluctance to call out one of our own kind is evidently one of our fundamental characteristics. Of lawyers:
    “Study after study has shown that the current rules for professional conduct are not enforced. Misconduct is rarely perceived. If perceived, it is not reported. If reported, it is not investigated. If investigated, violations are not found. If found, they are excused. If they are not excused, penalties are light. And if significant penalties are imposed, the lawyer soon returns to practice, in that state or another. Lawyers constantly condemn the failure of the criminal justice system to deter crime for precisely these reasons – because of its alleged indifference, procedural niceties, or excessive lenience. Indeed, we know that the efficacy of social control varies even more strongly with the likelihood of punishment than it does with the severity of the sanction. Yet on both counts, especially the former, the professional disciplinary system falls far below the wholly inadequate standards of the criminal law. Lawyers can hardly present their travesty of a penal system as an effective deterrent.” (“Why Does the ABA Promulgate Ethical Rules?” by Richard L. Abel, Connell Professor of Law, University of California at Los Angeles School of Law, from 59 Texas Law Review 639, 1981)

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