Why did SickKids allow ‘poison pen’ MD to stay?
Fifteen years before Motherisk, head of lab was outed as writer of disparaging letters to colleague
Fifteen years before scandal engulfed the Hospital for Sick Children’s Motherisk lab, SickKids, by its own acknowledgment, had every right to fire the doctor in the middle of it all.
In late1999, Dr. Gideon Koren was identified as the author of “poison pen letters” sent to SickKids doctors and the media during a heated dispute with a whistleblower colleague, Dr. Nancy Olivieri. For months, Koren had denied writing the anonymous letters that disparaged Olivieri and her four supporters as “a group of pigs,” among other insults. He confessed only after DNA testing provided irrefutable proof.
“Your actions constitute gross misconduct and provide sufficient grounds for dismissal,” the former presidents of SickKids and the University of Toronto wrote in an April 2000 decision following a disciplinary hearing on Koren, whom they upbraided for “repeatedly lying” and showing a “reckless dereliction of duty.”
But, citing his research achievements and the many young doctor she supervised, who they said would be“disproportionately disadvantaged” if Koren were fired, they instead docked him two months’ pay, fined him $35,000 and continued his suspension until June 1, 2000.
Koren remained head of the Motherisk Program he founded in 1985.
The Motherisk scandal has cast doubt over thousands of child protection decisions across Canada that relied on the hair-testing lab’s flawed drug and alcohol tests, and prompted a re-examination of some of the program’s influential research on drug safety in pregnancy.
It has also raised questions about the hospital’s decision to stand by Koren, which suggests “the institution valued image over the safety of patients,” said SickKids doctor Brenda Gallie, who was among Olivieri’s defenders.
James Turk, a Ryerson University professor and former head of the Canadian Association of University Teachers, which led an extensive investigation into the Olivieri affair, said the Motherisk crisis makes clear “there is a fundamental institutional problem that needs to be addressed.”
“(SickKids has) to detail what they did wrong in the past. Unless they can show they understand the problems they caused, there’s no reason to think that their solutions are going to solve those problems,” he said. “You can’t just say, let bygones be bygones.”
Koren is currently under investigation by the College of Physicians and Surgeons of Ontario, after SickKids sent the medical regulator findings from its internal investigation of Motherisk’s operations. Koren retired from SickKids in 2015 when the hospital closed the Motherisk lab and reassigned leadership of the Motherisk Program. He did not respond to requests for comment.
In an interview, SickKids CEO Michael Apkon detailed the steps the hospital has taken to prevent a repeat of the events at Motherisk, including new guidelines for expert evidence, and creating an externally supported “whistleblower hotline.” The hospital has also revised its conflict-of-interest policies in light of “concerns the public has raised about Dr. Koren’s research funding,” he said.
However, Apkon, who was appointed CEO in January 2014, would not discuss the Olivieri affair, saying, “I really can’t speak to the time prior to me being here.”
Rose Patten, the chair of the hospital’s governing board of trustees, also declined to comment. “The keen interest in the possibility of common themes across events of the past is appreciated and understandable. However, we find it really hard and inappropriate to speculate on actions or decisions that were taken on past events by others,” she said.
The faculties of pharmacy and medicine at the University of Toronto, where Koren held cross-appointments with SickKids, did not address questions about Koren’s past in an email response to queries from the Star.
Toronto criminal lawyer James Lockyer, who played a key role in exposing the Motherisk hair-testing scandal, said the silence is “ridiculous in these circumstances.”
A clinical toxicologist and pharmacologist, Koren published more than 1,500 articles over 40 years, according to SickKids. He rose to prominence in the hospital’s clinical toxicology department in the1980s with his creation of the pioneering Motherisk Program.
U of T estimates Koren supervised up to a dozen students per year. Many did placements in the Motherisk lab and its popular call centre, which is still operational.
In the mid-’90s, Olivieri, a blood diseases specialist, was spearheading efforts to find an oral treatment for children with thalassemia, a serious disorder that requires frequent blood transfusions, which can lead to a dangerous buildup of iron. At the time, the leading treatment to re- move the excess iron was an infusion administered overnight.
Hoping to find a replacement in deferiprone, Olivieri had designed a clinical trial, which she was running at SickKids with Koren, when they received partial funding from the drug maker Apotex.
When Olivieri began to voice concerns about the efficacy of the drug, which Koren did not share, Apotex alleged she was violating a confidentiality agreement, a claim she denied. The company threatened legal action.
The ensuing battle attracted significant media attention and divided doctors within SickKids, culminating with the infamous “poison pen letters.”
Koren told the Globe and Mail in 2000 that sending the letters “was inappropriate and unbecoming . . . but when you are attacked savagely by five people over three years, you may do these things.”
In its 2001 Olivieri Report, the Canadian Association of University Teachers found that Koren, along with another doctor, had submitted false testimony in an earlier probe commissioned by the hospital. It sharply criticized SickKids and U of T for their treatment of Olivieri, and for failing to defend her academic freedom in the face of patient safety concerns. The report also said Olivieri’s supporters defended her “at great personal cost.”
Among those defenders was Gallie, Olivieri’s supervisor at the time, who received an ultimatum from her boss in late 1998.
“You apparently believe that your moral duty overrides your accountability to me . . . and to the formal leadership of this institution,” said the letter, published in the Olivieri Report. “The choices are clear: Since you believe that your conscience compels you to denigrate this institution and its leadership, then you cannot at the same time be part of that leadership.”
Gallie continued to treat patients at SickKids but moved her lab, which does pioneering research in retinoblastoma, a rare form of eye cancer in young children, to Princess Margaret Hospital in 2000. She is currently an affiliate scientist at the University Health Network, and still treats patients at SickKids.
The controversy came just as U of T was negotiating with Apotex for a $20-million donation toward a research centre.
Arthur Schafer, founding director of the University of Manitoba’s Centre for Professional and Applied Ethics, said the hospital’s long-standing support of Koren is “directly tied to hubristic ambition.”
“Olivieri was seen as more than an inconvenience; she was seen as standing in the way of this ambition to make SickKids world class,” he said.
In 2003, the College of Physicians and Surgeons reprimanded and fined Koren $2,500 for his conduct, describing his behaviour as “childish, vindictive and dishonest.” The college said it supported an earlier finding of research misconduct against Koren by U of T for publishing research from the trial without Olivieri’s knowledge.
In publishing this research, Koren also failed to mention Olivieri’s concerns or to declare that his work was funded by Apotex, which used the publications “in communications with Health Canada to counter Dr. Olivieri’s adverse findings on its drug,” according to the Olivieri Report.
Apotex has always rejected concerns about the efficacy of deferiprone.
The $20-million funding with U of T never came to pass. In 2000 it was announced that Apotex had made a smaller multimillion-dollar donation to the university, the Olivieri Report said.
Apotex and Olivieri settled in 2014, Turk said. Olivieri moved her work to Toronto General Hospital, where she is currently a senior scientist.
In an email, she told the Star it was “agonizing . . . to learn of the families destroyed by the tragedy of Motherisk.”
She recalled her “shock” at the way U of T’s former dean of medicine “enthused about Koren’s ‘exemplary record’ and his ‘publication output’” when announcing the research misconduct finding to faculty, and at Western University’s 2004 decision to give Koren an endowed chair.
“All this begs the question: does the number of publications a scientist accumulates confer a diminished responsibility for repeated misconduct?” said Olivieri, who also runs Hemoglobal, a charity that treats children with blood diseases in Asia.
Dr. Michael Rieder, a pediatrics and pharmacology professor at Western University who said he is a longtime friend of Koren, was on the selection committee that gave him the endowed chair in 2004.
Rieder said it “was not an idle or inconsequential decision,” and that it was made after “due diligence” and lengthy discussion with Koren about the “reprehensible act” for which he had been disciplined.
“We agreed that given . . . some assurances that had been put in place, he would be a good hire,” Rieder said, citing Western’s conflict-of-interest policies and the fact that researchers don’t work in isolation. “The chair did very well and published a high volume of quality work, none of which was ever questioned.”
Koren still holds professor emeritus status at Western, a designation that the spokesperson for the school of medicine and dentistry said “allows him to access library and facilities but not to conduct research or teaching,” neither of which he is currently engaged in.
“Research related to Motherisk was wholly conducted at another institution,” she said.
Dr. Bhushan Kapur, who started working with Koren at SickKids in the ’90s, said, “At the Olivieri time, SickKids was divided into two parts: there was one section which hated him and the other section that supported him.”
Kapur, who supervised the Motherisk lab from 2009 to 2015, when he left SickKids, said he stuck by Koren because “he’s a very brilliant scientist” and “was a superb sounding board.”
Koren is currently living and working in Israel.
He is listed as a professor in the “big data” team at Maccabitech, the business development arm of the healthcare company Maccabi Group.
He is named on the “faculty/speaker” list of the 4th World Congress on Controversies in Pediatrics, which was held in Amsterdam earlier this spring.
Motherisk’s hair tests came under scrutiny in late 2014, following a Star investigation. At first, SickKids publicly defended the Motherisk lab and supported Koren’s position that the tests were reliable.
In a recent interview, Apkon said that when questions about the hair tests surfaced, the hospital consulted “a variety of internal sources … familiar with lab operations and with lab science.”
“We not only spoke to Dr. Koren,” he said.
Justice Susan Lang, who was appointed by the province to review Motherisk’s hair-strand drug and alcohol tests, concluded in December 2015 that SickKids had failed to provide “meaningful oversight” of the lab, whose hair tests, used in thousands of child protection cases, “fell woefully short” of the standards required of evidence presented in legal cases.
Lang’s review also identified incorrect statements about Motherisk’s hair testing methods in several scientific journal articles co-authored by Koren. One of those journals, Therapeutic Drug Monitoring, recently told the Star it is investigating 90 articles that dealt with potential Motherisk data or were published by Koren “in light of ongoing concerns and investigations of Dr. Koren’s work.”
Koren was replaced as head of the Motherisk Program in spring 2015 after the Star raised questions about the failure to disclose financial support from Quebec-based Duchesnay, the maker of Diclectin, in a booklet on the Motherisk website that Koren co-authored, which promoted the use of the morning sickness drug. (SickKids subsequently added disclosures.)
The results of an internal hospital investigation confirmed Koren’s undisclosed conflicts of interest related to Duchesnay, as well as flaws in an influential 1997 meta-study that Koren co-authored on Diclectin.
SickKids also identified a significant privacy breach in the Motherisk call centre in which1,400 call records over more than a decade were accessed “for research-related purposes, without first going through our established process for research approval.”
In an email to the Star, SickKids said it acknowledged “questions regarding Dr. Koren’s relationship with Duchesnay … may raise concerns for members of the public,” but stressed that drug safety advice dispatched in the call centre “is not solely dependent on Motherisk research.”
Olivieri said it ‘agonizing’ to read about the Motherisk scandal more than 15 years after what she had been through