Neuro-Endocrine Tumours Update

It is clear that a great deal of misinformation has been given to patients with neuro-endocrine tumours (NETs) so UHN is sending you the facts about the program. Please feel free to post it to the petition that is under way at change.org, addressed to our President & CEO.

Our prime concern is that patients are being told that the program is being dismantled. Nothing could be further from the truth and if this information is being relayed by physicians in the program, it is unprofessional and concerning to us. The NETs program is an important program for cancer patients in the Province of Ontario, and we are concerned that patients are being unnecessarily alarmed based on inaccurate information.

We have provided information below which we trust will stop the false rumours that are being circulated.

Clinical program at Princess Margaret – NETs

• We recognize that this program and the professionals providing the care are valued by our patients. This is a field of cancer care, research and teaching that involves many professionals and last year Princess Margaret provided care to over 300 individuals with these cancers.
• Patients continue to have access to excellent professionals with an interest and expertise in NETs including pathologists, surgical oncologists, radiation oncologists, medical oncologists, imaging and nuclear medicine professionals, endocrinologists, geneticists, nurses and supportive care professionals.
• We have recently recruited an additional endocrinologist and a surgeon with a specialized interest in NETs.
• In addition to the recent recruits, we have no indication that Dr. Ezzat intends to discontinue his clinical practice at UHN. Should he advise otherwise, we will take steps to recruit someone with his clinical expertise to join our program.
• There seems to be a great deal of confusion about the effect of the closure of one specific research laboratory at UHN on the clinical services available to NETs patients. It is true that following a thorough investigation by 2 separate Investigation Committees, Drs. Asa and Ezzat’s basic research laboratory has been closed as a result of findings of research misconduct made against them in the form of material non-compliance with accepted standards in the scientific community.
• These findings of research misconduct have now been upheld by the Ontario Divisional Court on two separate occasions following two separate challenges by Drs. Asa and Ezzat. However, we can assure you that the closure of this research laboratory has had no impact on the clinical services that continue to be available to NETs patients at UHN.

Research investigation and closure of laboratory

• Concerns were raised to UHN and the University of Toronto from multiple external sources (individuals and journals) with respect to a total of 30 papers published over a 10 year period, on research originating from Drs. Asa and Ezzat’s research laboratory.
• There are accepted standards in the scientific community about how research is conducted and reported. UHN – as well as the public and scientific community – expect that Principal Investigators conducting research at UHN maintain the highest standards in their research. When research papers are called into question – as was the case here – UHN has a duty to conduct an inquiry to determine whether a full investigation is warranted. In this case – given the serious nature of the concerns about so many images in so many papers published over a 10 years period – the inquiry determined that a full investigation was necessary.
• The investigation happened in two phases by two separate expert panels that included external reviewers. Both panels concluded that Drs. Asa and Ezzat had engaged in research misconduct in the form of material non-compliance with applicable standards in the scientific community.
• Drs. Asa and Ezzat challenged the findings of research misconduct that were made against them by the two Investigation Committees all the way up to the Ontario Divisional Court. In both cases, the Court upheld the findings of research misconduct (in the form of material non-compliance with applicable standards in the scientific community), and affirmed that UHN’s process for investigation and appeal was reasonable and fair.
• Drs. Asa and Ezzat sought leave to appeal the 2nd decision of the Divisional Court to the Ontario Court of Appeal, but leave was not granted. Consequently, the findings of research misconduct are now final.
• Drs. Asa and Ezzat have consistently taken the position that the results of their work should stand, notwithstanding the final findings of research misconduct made against them. Their apparent disregard for the image improprieties in their publications, and their inability in several cases to produce original data supporting the publications in question, is suggestive of a lack of rigour in the way their research laboratory was run. As Principal Investigators, they bear ultimate responsibility for all work originating from their research lab.
• To date, publishing journals have retracted four papers on which Drs. Asa and Ezzat are authors. One additional journal indicated it had concerns about another paper and published a Notice to that effect. Additional journals are currently considering what action they intend to take with respect to a number of other papers that are of concern.
• UHN has now notified the funding agencies which supported the research in question, as well as the University of Toronto – notifications which are mandated by these agencies and the University.
• The findings of research misconduct against Drs. Asa and Ezzat are very serious and they have now been upheld by the Ontario Divisional Court on 2 separate occasions. In light of this fact, as well as UHN’s ongoing commitment to the integrity and rigour of any research undertaken at UHN, the closure of Drs. Asa and Ezzat’s research laboratory is warranted in these circumstances.

We can assure NETs patients that neither the closure of their research lab, nor any other operational decision related to Drs. Asa and Ezzat, amount to the ‘dismantling’ of this important program. The NETs program continues to be an integral component of UHN’s service offerings, and as outlined above, we are confident NETs patients will continue to enjoy the excellent care and scholarly activity they have come to expect from UHN. Any suggestion to the contrary is both factually untrue and unnecessarily alarming to patients and family members who depend on this program for their care.

Mary Gospodarowicz, MD FRCPC FRCR(Hon)
Medical Director, Princess Margaret Cancer Centre
Regional Vice-President Cancer Care Ontario, Toronto
University Professor, University of Toronto

Marnie Escaf, MHA, HBBA
Senior Vice President
Executive Lead, Princess Margaret Cancer Centre
University Health Network
Princess Margaret Cancer Centre
Room 16-612
Toronto ON M5G 2M9

Brad G. Wouters
Senior Scientist, Princess Margaret Cancer Centre
Executive Vice-President, Science and Research
University Health Network​​​​​​​​​​​