Inappropriate sexual relationships of the sort Axel Grothey engaged in at Mayo Clinic may be all too common.
The Grothey case is unique, because it has slipped out from under the cloak of confidentiality, making Grothey into a symbol of sexual misconduct, including abuse of power in the relationship between mentor and mentee.
The Cancer Letter’s story about Grothey’s misconduct has sparked a brush fire on social media. Hundreds of people spoke openly and loudly about a problem that is usually whispered about.
A groundswell of indignation and calls for accountability put pressure on the organizations that kept Grothey in leadership roles:
- Reacting to the story, NCI has removed Grothey from his position as co-chair of the NCI National Clinical Trials Network Gastrointestinal Steering Committee.
- The American Society of Clinical Oncology has disallowed Grothey from presenting at its 2021 virtual annual meeting June 4-8 and initiated formal disciplinary procedures.
- OneOncology, where Grothey was medical director of OneOncology Research Network, has removed him from that role.
- West Cancer Center, where Grothey is director of GI cancer research, said the oncology practice initiated an investigation.
- The University of Tennessee has started an investigation. Grothey has no formal affiliation with the university, but medical students have in the past rotated to West Cancer Center, where some may have been informally mentored by Grothey, officials said.
The list of groups that have censured or barred Grothey includes the COVID-19 and Cancer Consortium, Alliance for Clinical Trials in Oncology, ECOG-ACRIN Cancer Research Group, Fight Colorectal Cancer, and OncoAlert.
The message from the oncology community is clear: those who engage in sexual misconduct face penalties that include getting kicked off NCI advisory boards, thrown out of cooperative groups and editorial boards, fired, and barred from presenting at meetings of professional societies.
But none of this will matter much if the issue is limited to the misdeeds of one man rather than focusing on a pervasive problem in the culture of medicine, women in oncology warn.
The Hematology/Oncology women’s Facebook group, also nicknamed The Wolfpack, has been rattled with heated discussions of gender equity in the aftermath of the Grothey story, which group members regard as just one example of how sexual misconduct and gender bias against women is systemic throughout oncology (The Cancer Letter, Oct. 2, 2020).
The Cancer Letter has compiled a Twitter Moment highlighting some of the discussions, feedback, and policy suggestions that have emerged in the wake of the Grothey story.
Selected tweets from #OncTwitter conversations follow:
- “I was shocked to read the @TheCancerLetter piece today. Heard from many colleagues that this behavior was known in the field and went on for years. Years.” – @CharuAggarwalMD
- “Everyone knows someone. But nobody does anything. The onus is on those who have the most to lose (the junior faculty, the resident/fellow) to report when often they are desperate to move on from trauma. How can we support our most vulnerable to make themselves more vulnerable?” – @fumikochino
- “I’m an oncologist with access to the most powerful anti-nausea drugs in the world but this paragraph has been making my stomach turn since I first read it in @TheCancerLetter last night. Lechery has no place in medicine or the academy.” – @marklewismd
- “Maybe *this* is a new role of professional societies: If a faculty member is released after internal review process finds them wanting—it’s reported to professional societies to create institutional memory nationally &confidentially. Then a tipping point is identified.” – @DrSGraff
- “Alright – I’m about done with the ‘I’m shocked’ phase of this story and ready to move into what WE (the individuals who can collectively impart change) do. I think we need this. It’s our profession, our mentees and our collective future.” – @TGeorgeMD
- “UCSF HemOnc Fellows: For Roundtable this Friday, let’s start this conversation locally. What are our program and institutional policies? What are their strengths and deficiencies in supporting victims and bringing about accountability? How do we achieve zero tolerance?” – @HemoncUcsf
One of the leaders of the Wolf Pack said that many women oncologists in the closed Facebook group were asking for what amounts to legal advice, seeking to understand the range of possible repercussions individuals could face as a consequence of reporting sexual misconduct by colleagues and mentors.
Mayo explains policy
In a paper published in Mayo Clinic Proceedings last year, the institution summarized the handling of sexual harassment claims on its campuses in Rochester, Arizona, and Florida.
Of the 88 substantiated allegations reported from 2017 to 2019, 31 individuals—including nine physician-scientists—received formal coaching; 22—including three physician-scientists—received warnings; and 35—including 10 physician-scientists—were terminated from employment or resigned before termination.
The paper didn’t separate those who were terminated from employment from those who were allowed to resign under threat of termination.
Documents obtained by The Cancer Letter show that an internal investigation at Mayo had recommended that Grothey be dismissed, which prompted him to resign.
Mayo Clinic’s Charanjit S. Rihal, chair of the Personnel Committee and corresponding author of the paper, said that all instances of sexual harassment that result in the end of employment are reported to the Minnesota Board of Medical Practice, regardless of whether the individual resigns or is fired.
Said Rihal:
Respect for patients and colleagues is a core value of Mayo Clinic, and our organization takes sexual and other forms of harassment in the workplace seriously.
Staff members have many resources available to them and are encouraged to speak up if they see or experience behaviors inconsistent with the values of our organization.
When any physician is recommended for termination, the organization has made a determination that the person has engaged in serious misconduct which is in violation of its core policies and values to such a degree that an employment relationship can no longer exist.
The fact that someone may quit before the ultimate conclusion is reached does not negate the organization’s stance or impact post-separation action.
All instances of sexual harassment are reported to the board of medical practice, regardless of whether a resignation or termination occurs. Mayo Clinic fully cooperates with board investigations of reported sexually harassing behavior and complies with subpoenas that are issued by state boards.
Mayo Clinic also provides truthful information about corrective action taken when references are requested and credentialing inquiries occur, and encourages all organizations to perform thorough background and reference checks on all prospective hires.
Rihal said the paper didn’t distinguish between termination and resignation under threat of termination because these categories are equivalent.
Mayo Clinic’s article focused on our institutional approach to addressing sexual harassment, and not on the broader issue of how other entities can coordinate efforts to eliminate harassing behavior across healthcare.
Our article did not distinguish between termination and resignation because they are the substantially equivalent, as both occur after Mayo Clinic has made a recommendation for termination.
As previously stated, even when a resignation occurs prior to completion of the termination process, Mayo Clinic takes necessary actions, which include board reporting and cooperation with subpoenas issued by state boards.
Mayo Clinic also provides truthful information in connection with reference requests and credentialing inquiries. Mayo Clinic does not enter into severance or confidentiality agreements when a determination has been made that sexually harassing behavior has occurred.
If this statement is correct, licensure boards in other states as well as prospective employers would have been able to obtain accurate information about the circumstances of Grothey’s departure from Mayo.
The Tennessee Department of Health, which in 2019 granted Grothey a license to practice medicine in the state, declined to comment on the matter. In three questionnaires submitted to state authorities, Grothey said he had not been disciplined or been forced to resign from any institution. On two occasions, Grothey responded “NO” to the following question:
- “Within the previous ten (10) years, have you ever been asked to or allowed to resign from or had any medical staff privileges restricted or not renewed by any hospital in lieu of or in settlement of a pending disciplinary action related to competence or character?”
Statements by organizations that condemned Grothey’s sexual misconduct follow:
ASCO
Dr. Axel Grothey acknowledged a pattern of sexual misconduct, was reprimanded by state licensure boards and resigned from his employment rather than face termination for unethical sexual conduct.
Upon becoming aware of this abuse of power, ASCO initiated formal member discipline procedures and invoked its Event Conduct Policy to disallow Dr. Grothey from presenting at the 2021 ASCO Annual Meeting. Dr. Grothey is not an ASCO volunteer and is not eligible to be a volunteer while member discipline proceedings are pending.
ASCO policies and actions reflect an expectation that members of the Society will exercise professionalism, consideration, and respect in their speech and actions with zero tolerance for harassment or abuse of power.
ASCO also tweeted:
@ASCO: Our policy is that we have zero tolerance for sexual harassment in the workplace, at ASCO events, and by our members/volunteers/faculty https://fal.cn/3fNT2
In light of Dr. Grothey’s admission of sexual misconduct & discipline by state medical boards, we have initiated formal member discipline procedures as well as invoked our Event Conduct Policy to disallow Dr. Grothey from presenting at #ASCO21
Thru our programs we’re committed to promoting a culture of respect, equity, safety & accountability in the workplace & onc community. Join us Fri 6/4 at #ASCO21 for sessions on Moving Toward Equity & Dismantling Gender Disparities https://fal.cn/3fOys
We plan to continue this important conversation & invite women in oncology to join us for a prof dev webinar & discussion on gender bias & harassment in the workplace on 6/21 at 4 PM ET. Register surveymonkey.com/r/29WNXL6
OneOncology
We strongly condemn inappropriate workplace conduct of any nature, and as a result we are removing Dr. Grothey as medical director of OneR.
While Dr. Grothey is not a OneOncology employee, what we’ve recently learned regarding his actions at the Mayo Clinic does not align with our values and the Code of Conduct to which we hold our employees and contractors.
West Cancer Center
To uphold our commitment to workplace integrity and transparency, we’ve launched an internal investigation into Dr. Grothey.
Per company policy, we will not discuss ongoing personnel matters of current or past employees.
The University of Tennessee
The University of Tennessee does not have a relationship with Dr. Grothey. He is not on our faculty. He is not an employee of the University of Tennessee, neither in a volunteer nor in any sort of a paid position.
We do have a fellowship program in medical oncology, and so, as part of that program, early on, some of our fellows could rotate with him—but it was on an informal basis, because he did not have a faculty appointment.
Once an allegation comes to the surface, our primary goal is to make sure that all of our learners—and by that I include any learner, has an educational experience that is free of any sort of sexual overtone, sexual harassment, etc.
We are deeply committed to that as part of our overall learning environment. If we ever become aware of anything that could impact any of our trainees, we’re going to look into that.
This has no place in a mentor-mentee environment, and just simply can’t exist in academic medicine.
Scott E. Strome, MD
Robert Kaplan Executive Dean
Vice Chancellor for Clinical Affairs
University of Tennessee Health Science Center College of Medicine
Alliance
Last Friday, the oncology community became aware of allegations of improper conduct by a former Alliance member, Dr. Axel Grothey, following the publication of a Cancer Letter article detailing this issue.
The article raises many troubling issues for our community. It is absolutely clear that abusive or bullying behavior of any form cannot be tolerated, and it is particularly egregious if an individual in a position of authority or power uses these tactics to coerce more vulnerable colleagues.
None of us, no matter what our relative status, can abdicate responsibility for maintaining a professional environment that is respectful and supportive of all our members.
When difficult situations arise, each of us can be a force for positive change. This current event reminds us all how important it is to care, to listen, and to support our colleagues in the best way we know how.
Monica Bertagnolli, MD
Group chair
ECOG-ACRIN
The publication last week in The Cancer Letter documents allegations of misconduct by a colleague in the GI cancer community. ECOG-ACRIN unequivocally stands against sexual harassment in any form.
The attention brought to this matter is critical for all concerned, and for our broader cancer research community. It speaks to the care and respect we must exercise in our professional environments, each doing our part to eliminate inequality and inequity, and to support vulnerable persons. We must cultivate an environment in which we all can thrive.
In ECOG-ACRIN we are committed to gender equity, equity in sexual orientation, and we have espoused a specifically anti-racist stance. This process—which has been and will be a long-term commitment on our part—will be accelerated by a specific committee charged to focus on issues related to gender representation and equality.
Peter J. O’Dwyer, MD
Group co-chair
Mitchell D. Schnall, MD, PhD
Group co-chair
The COVID-19 and Cancer Consortium
By now, most of you who are regularly on social media or are regular readers of The Cancer Letter will have seen the piece on Dr. Axel Grothey, one of the first members of the COVID-19 and Cancer Consortium. While every story has (at least) two sides, the accusations appear credible and substantiated, and the National Cancer Institute has already taken the step of removing Dr. Grothey from the National Clinical Trials Network’s Gastrointestinal Steering Committee.
Just as the SARS-CoV-2 pandemic was a moment of crisis that brought us together, we must use these difficult moments to catalyze change. CCC19 takes a stand for fairness, transparency, and ethical rigor, and so it is that the Steering Committee voted to remove Dr. Grothey from CCC19, effective immediately. Rest assured that these decisions are not made lightly, but we must have zero tolerance for such violations of the CCC19 Code of Conduct, whether they occurred before the existence of CCC19, or not.
We invite you to review the Code of Conduct, which is available in the shared Box folder. We also want to state plainly that we strongly support equality and diversity in our field, and will not hesitate to take such action again, if needed. We sincerely hope that it will not, but if you have concerns that you would like to share privately with the Steering Committee, we can assure you that such communications will remain confidential.
The CCC19 Steering Committee
AACR
While we do not have the information needed to provide a statement related to the details of The Cancer Letter article last week, we wish to inform you of the AACR’s Non-Discrimination and Sexual Harassment Policy that states:
The American Association for Cancer Research is committed to a work environment in which all individuals are treated with respect and dignity. Each individual has the right to work in a professional atmosphere that promotes equal employment opportunities and prohibits discriminatory practices, including harassment.
The AACR enforces a Code of Conduct that “prohibits intimidating, threatening, or harassing conduct of any kind. This applies to all conference participants—attendees, presenters, exhibitors, staff, vendors, etc.”
Further, “The AACR is committed to a safe, hospitable, and productive environment for all conference participants, regardless of age, disability, ethnicity, gender, religion, or sexual orientation.”
OncoAlert
@OncoAlert: Due to the events recently published at “The Cancer Letter” & after verifying this with colleagues. We have removed Axel Grothey from the OncoAlert Network.
The OncoAlert network makes it perfectly clear that we have ZERO tolerance for abuse & harassment of ANY KIND & stand by our values.
Fight Colorectal Cancer
@AnjeeDavis: TY to the @TheCancerLetter for reporting predatory behavior exploiting women in the scientific community. Effective immediately Axel Grothey is removed from @FightCRC Medical Advisory Board.
Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center
@YaleCOPPER: Horrible example of serial harassment. One of many. Misogyny in academia has to stop. As we struggle against #cancer in our clinical care, research, the oncology community must acknowledge that sexism is also a #cancer in our midst. #ListentoWomen #BelieveWomen #HeForShe
Cancer Center at Brown University
@BrownUCancer: It is long overdue to have a culture that supports and celebrates individuals without harassment, abuse, or racism. Certain behaviors as described are unacceptable period. Those affected must be empowered to speak up to make those in leadership aware so swift action can be taken.
NRG Oncology
@NRGonc: In wake of @TheCancerLetter reporting of women exploited yet again in the scientific community, we are deeply saddened it affected the mentor-mentee relationship, critical to our future. Together, we must change this while continuing to support those & other victims. #HeForShe
NIH
We are reviewing our processes for responding to people who submit to NIH allegations of sexual harassment by individuals affiliated with NIH.
We want to ensure we are being responsive and that our policies and procedures are clearly articulated to the person submitting the allegation so they know what to expect next.
The Grothey scandal broke at a time when NIH is facing congressional scrutiny over its policing of sexual harassment.
In the past, NIH has insisted that it’s up to institutions to regulate ethics of their faculty members. NIH doesn’t have specific rules or policies for handling matters of moral turpitude on the part of grantees.
However, NCI Director Ned Sharpless acted decisively on May 27, firing Grothey from an influential role as co-chair of the NCI NCTN GI Steering Committee (The Cancer Letter, May 28, 2021).
The day before the Grothey story was published, NIH Director Francis Collins faced sharp criticism from Sen. Patty Murray (D-WA), chair of the Senate appropriations subcommittee on Labor, Health and Human Services, Education, and Related Agencies.
A video appears here, and a transcript of the exchange follows:
Murray: In 2018, the National Academies, as you know, released a report that found that nearly 60% of women in academia have experienced—60%—have experienced sexual harassment on the job, and recommended that federal research agencies require institutions to notify them when individuals on grants have violated harassment policies, or are put on administrative leave due to harassment allegations.
Other science agencies like National Science Foundation have implemented these changes. Tell me, what is NIH doing to require its research institutes to do the same?
Collins: Senator, I share the sense that this is an extremely important issue.
The National Academy report that you mentioned, I think really got everybody to recognize how pervasive sexual harassment is and what a significant negative it has been for far too long for women in our scientific workforce.
We conducted our own working group, the Advisory Committee to the Director, that reported to me in December of 2019, and made a series of very significant recommendations about how we might change our approach to this.
We have been working through those, and have already implemented a significant fraction of them.There are some that still require some additional legal authority that is hard for us to be able to do at the present time.
In terms of what you’re particularly pointing to, we have had now more than 300 allegations that have been brought to us about sexual harassment in our grantee institutions, others within our own intramural program.
Of those 300, about 30% of them have been turned out to be actually entirely validated. That has resulted in 100 different changes in grants—particularly, removal of principal investigators and replacement of those with other individuals. 125 individuals have been taken out of our pool of peer reviewers because of this kind of concern about the bias that they bring to that experience.
And we have made it very clear to our institutions that we expect them to report any—
Murray: Expecting them doesn’t require them to.
Collins: Senator, you and I are in an interesting discussion here […]. I wish we were able to simply require—at the present time, legally, we are told we don’t have that authority. We would have to go through a two-year rulemaking effort, or we would need statutory assistance.
Murray: OK. This is really important, and whatever we need to do. I know you’ve worked on it, I know you’ve focused on it, but I know of women who have left our scientific research institutes because of this.
We can’t afford to have that happen for a thousand reasons. Whatever it is we need to do here, we need to know what it is so we can do it.
Collins: I am so with you […] I will say, that what we’ve said in terms of expecting response from our institutions, has gotten their attention in a pretty remarkable way, even without requiring it. We are seeing reporting coming through.
Murray: Well, to every one of them that’s listening, I’m not done with this.
Collins: OK.
Matthew Bin Han Ong and Katie Goldberg contributed to this story.
