Report from the Investigation Commission appointed by Rikshospitalet – Radiumhospitalet mc and the University of Oslo January 18, 2006

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The subject matter of the doctor degree project

Background: No methods exist to indicate which oral dysplasias may also develop into cancer.
Goal I: The project description from 1993 states that Sudbø and Reith wanted to study the malignant transformation potential through a historical prospective study of leukoplakia materials, in order to map out any structural DNA changes in dysplasias, and compare these findings with the persons who later on developed cancer. They also wanted to start a prospective study. The aim was to be able to say something about the prognosis of premalignant conditions. Image analysis methods were also to be tested. The material for the historical prospective study was according to the project description already available, whereas the material for the prospective study was to be obtained by scraping of suspicious mucous areas.
Goal II: In addition they wanted to study manifest cancers. The hope was to map out the DNA changes which identify cancers with a good and poor prognosis. The project description states that the material had

been collected. Sudbø has stated that he is unable to understand that the project description states that the material had already been collected. He alleges that there is no doubt that this material was collected after he started as a recruitment fellow. The Commission finds it predominantly likely that Sudbø, in a project which he had just heard about a few weeks before, did not at this point in time have the opportunity to collect the material in advance. Sudbø assumes that the project description is formulated to reflect that the project had been prepared by Reith. The Commission finds, and this is supported by Reith, that the formulation in the project description reflects the fact that Reith through his contacts had knowledge about the material that had been collected at Gade’s Institute (and possibly also the material from the faculty of odontology), to which the Commission will revert later on.

      1. The organization of the PhD project

Jon Sudbø’s PhD project was carried out during the period 1993-2001. The PhD project has a rather unclear, but at that time hardly unusual, basis and organizational structure, which the Commission has seen reason to try to clarify and to which it will relate some remarks. The organization of the PhD project and the formalities in that connection, is, i.a., of great importance to the everyday as well as the overall responsibility for the planning, implementation and completion (reporting) of the project.

Jon Sudbø first received stipend funds from the Cancer Society from January 1st 1994 till December 31st 1996. In 1996 he was in addition granted a finalizing year. During this period, the Cancer Society formally was his employer. As from August 1, 1996 until January 19, 1998, Sudbø obtained a leave of absence to complete his internship. In addition, he ran his own private dentist practice at Årvoll Dentist Center sharing an office with some colleagues.

During the two first years, Sudbø did not have a formal employment relationship at Radiumhospitalet. But his main supervisor – Albrecht Reith – was employed as a researcher at the department of pathology, division for digital pathology. According to the usual practice when projects were financed externally, office space and the practical organization of Jon Sudbø’s work were arranged at this department. From January to September 2000, Sudbø received a stipend from the cancer research institute at the Radiumhospitalet, and he was then formally temporarily employed at the Radiumhospitalet. The head of the department of pathology was, and is, Professor Jahn Nesland MD. Professor Håvard Danielsen PhD was head of section at the division for digital pathology.

Sudbø has expressed surprise that he did not have any formal employment relationship at the Radiumhospitalet the first years when he worked at the department of pathology, among other things

because Jahn M. Nesland in his capacity as departmental chief physician recommended the application to the Cancer Society. He also alleges that it was not until 2005 that he realized that Reith was not a professor at the University of Oslo.

In any case, it is a fact that Jon Sudbø and Reith performed their daily work at the Radiumhospitalet, and that the research took place there. This fact was known and accepted by the Radiumhospitalet. The Commission will also point out, as stated by Reith, that Sudbø’s PhD work was a continuation of three other PhD works which Reith had supervised prior to Sudbø’s project, and that these four projects, which were all supported by the Cancer Society, were concentrated on the same matter – the connection between early stages of cancer and subsequently developed cancer.

Thus, the Commission finds that the real association with the Radiumhospitalet appears as so strong that in reality one is dealing with an association relationship which is fully comparable with an employment relationship. Accordingly, the Commission finds that the Radiumhospitalet has had a customary daily management and instruction right in relation to Jon Sudbø during the entire PhD period, and that the research has taken place under the auspices of the Radiumhospitalet. Most of the conversations with the Commission are clearly indicative of this. It is also, for example, evident that both Gade’s Institute in Bergen and the Cancer Registry related to the Radiumhospitalet as an institution, and not to Jon Sudbø as a private person. The latter would also be contrary to expectations.

The Commission thus finds that the Radiumhospitalet had the primary responsibility for Jon Sudbø’s research.

It was not until November 2000 that Sudbø applied for admission to the PhD program at the University of Oslo. It was then fairly obvious that the dissertation was already as good as completed. When the management of the University of Oslo informed Sudbø of the fact that he had not been admitted to the program, he brought this up with Reith, who according to Sudbø’s statement made the excuse that it was all an oversight. Sudbø has underlined that he – in spite of failing to be admitted to the PhD program – had participated “in all the mandatory research education courses” and that these were paid for by the Radiumhospitalet. The Commission has not found it serviceable to deal with this in more detail.

Sudbø was admitted to the program at the end of December of the same year, at the same time as the dissertation was submitted. Sudbø’s dissertation was approved on February 20, 2001. The presentation of the thesis took place on March 9, 2001, and he was created a doctor in June, 2001. The main supervisor was Albrecht Reith. Since Reith was not a professor at the University of Oslo, Jahn Nesland, who held a professor II position at the University of Oslo, was appointed so-called contact supervisor. Nesland was the only one at the department who had such link to the University of Oslo, and he therefore held a series of such administrative positions. His position as contact supervisor was, in other words, established for formal reasons, by Nesland acting as the connecting link between the University of Oslo and Sudbø. Real supervision by Nesland was not an issue to any particular degree. Consequently, Nesland is not a coauthor of any of the publications resulting from the PhD project. The University of Oslo has thus primarily been responsible for the approval of the dissertation and the thesis. The Cancer Society has exclusively acted as a funding source, and has not had anything to do with the organization and implementation of the project.

Conversations with the Commission clearly indicate that Jon Sudbø had a relatively free position as a fellow, a situation that is not unusual. Sudbø is described as clever, ambitious, experienced and independent compared with other fellows. Reith had a wide network which was used to obtain patient material among other things. Sudbø and Reith had a close relationship, with almost daily contact, during which professional questions seem to have been regularly discussed, although on a more general level. Reith has thus obviously been more peripheral in relation to being involved in the data material, data analyses and the like. Consequently, Reith’s role appears more as an active mentor than a co-researcher, see section 3.7 above.

However, Sudbø has denied that he had such a free position. He has alleged that his work efforts “clearly were directed by Albrecht Reith” and believes that it is not correct that Reith’s role can be described as a mentor role. Sudbø believes he can support this by referring to his work effort, when he took up the position in 1994, being directed towards work with graph theory analysis on carcinoma, first prostate carcinoma and subsequently oral carcinoma. Sudbø points out that this was not at all comprised by the original project description. Sudbø has alleged that when he commented on this to Reith, he was told that he should nevertheless commence with this work, and that one could later on revert to the work related to the original project description. Thus, Sudbø is of the opinion that Reith redefined Sudbø’s research project in the direction of method development. The reason for this change is allegedly that Reith had invited a French researcher to the Radiumhospitalet, Raphael Marcelpoil, as a post doc. for 12 months, after Reith having been an evaluator at Marcelpoil’s presentation of his thesis in 1993. Sudbø has alleged that the work with the graph theory analysis represented the entirely dominating part of his research effort up to 1999. The Commission understands Sudbø to believe that in this work he was dependant on cooperation with others to such a degree that this does not give grounds for finding that he had a free and independent position as a research fellow, nor that Reith had a withdrawn role as supervisor. The Commission moreover understands Sudbø such that the work that was comprised by the original project description (oral premalignant diseases), and which was to comprise analyses of the material from Gade’s Institute and the Faculty of Odontology at the University of Oslo, was not given priority in the period up to 1999. Reith refutes however that he is supposed to have instructed Sudbø to give priority to the work with the graph theory, and that this in all essentials was Sudbø’s priority. This explanation is clearly supported by a memo written by Sudbø in 2000, in which is stated that “it appeared absolutely obvious to the undersigned [Jon Sudbø] during most of my time as a research fellow that these methods [the graph theory] sooner or later would provide results, which was the reason I continued to

work with them, although Reith and the undersigned several times discussed my priorities in this respect”.

In spite of Reith’s close contact with Jon Sudbø, and Sudbø’s description of this relationship later on, to the Commission the project first and foremost appears as Sudbø’s own project, in which he himself took care of the everyday research. It seems as if it is he alone who in fact had the full control of the research project, including the research material that came from Gade and the Faculty of Odontology, see also the letter from Sudbø to the Cancer Registry dated February 20, 1996, cited under section 4.2.7, and the letter of reply of March 22, 1996.

Accordingly, the Commission finds that Jon Sudbø de facto was the project manager for the PhD project, a description with which Sudbø strongly disagree. The Commission also finds that Albrecht Reith has been the supervisor and mentor for the project.

The responsibility thus seems divided with the individual person/institution having an independent responsibility. The individual person’s/institution’s detailed responsibilities, and what they consist of, will vary, and for that reason they must be assessed specifically.

The Commission notes that the fact that responsibilities apparently have been relatively unclear and unheeded in this case, is first and foremost an institutional management responsibility.

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