Paolo Macchiarini, MD, is a thoracic surgeon and regenerative medicine researcher who gained international fame for pioneering surgeries that involved implanting synthetic tracheas seeded with the patient’s own stem cells. However, Macchiarini’s career came to a halt when allegations of scientific misconduct, ethical breaches, and fraudulent practices surfaced. Several of his patients experienced severe complications, and some died as a result of his experimental surgeries. Investigations revealed that Macchiarini had falsified data and misrepresented the success of his procedures. His actions led to legal consequences: he was convicted in 2022 by a Swedish court for causing felony bodily injury.

Farid Fata, MD, is a Detroit area hematologist-oncologist who was sentenced in 2015 to serve 45 years in prison for his role in a health care fraud scheme that included administering medically unnecessary infusions or injections to 553 individual patients and submitting to Medicare and private insurance companies approximately $34 million in fraudulent claims. He caused grievous emotional and physical harm to patients by falsely diagnosing them with cancer and providing unnecessary chemotherapy.

Michael Swango, MD, is a physician who became a serial killer, poisoned patients and colleagues, and manipulated his way through multiple medical institutions, leaving a trail of mysterious patient deaths, possibly as many as 60. His charm and ability to deceive colleagues and law enforcement authorities allowed him to evade detection for 20 years while he continued his killing spree. Swango was sentenced in 2000 to three consecutive life terms without the possibility of parole.

All of these doctors exploited their positions of power, relying on the assumption that physicians are inherently trustworthy and competent. They illustrate that the allure of power and recognition can sometimes lead individuals down a very dark path, and they are a stark reminder that even medicine is not immune to the actions of con-men.

Throughout history, there have been other medical professionals involved in fraudulent activities, typically motivated by ambition, narcissism, and a quest for fame or financial gain. However, it seems that none have crafted stories as sensational as Macchiarini. In the words of Meredith Vieira: “He’s the doctor who does the seemingly impossible, going where no other has yet dared.”

Just ask Benita Alexander, an Emmy award-winning journalist and producer who was responsible for the documentary “A Leap of Faith,” hosted by Vieira and aired on NBC on June 1, 2016. While filming was occurring in 2013, Alexander fell in love with Macchiarini, who was the subject of the documentary. Apart from her breach of journalistic ethics, Alexander was swept into a marriage proposal and lavish wedding plans that Macchiarini said would be officiated by Pope Francis and include Elton John and John Legend for entertainment. Andrea Bocelli was to serenade the couple, and attendees would include the Obamas, the Clintons, and other celebrities.

The reckoning occurred when Alexander learned that Macchiarini’s peripatetic studies and distinguished medical pedigree were half-baked (think George Santos). With the help of a private investigator, she discovered that virtually every detail Macchiarini provided about the wedding was false. Additionally, he was living with a woman and two children in Barcelona, and it was not entirely certain whether Macchiarini had actually obtained a legal divorce from his first wife.

Macchiarini’s Munchausen life was outlined in Vanity Fair. Ronald Schouten, MD, JD, director of the law and psychiatry service and the MGH/Harvard Forensic Psychiatry Fellowship, and an associate professor of psychiatry at Harvard Medical School, was interviewed for the article and quoted as saying, “Macchiarini is the extreme form of a con-man. He’s clearly bright and has accomplishments, but he can’t contain himself. There’s a void in his personality that he seems to want to fill by conning more and more people … This guy is really good.”

The psychology of con-men in medicine often involves complex personality traits and psychological disorders. Many con-men exhibit characteristics of narcissistic personality disorder, which includes a grandiose sense of self-importance, a need for excessive admiration, and a lack of empathy for others. These traits can drive individuals to manipulate and deceive people to maintain their self-image and achieve their goals. In the context of medicine, this can manifest as falsifying research, performing unnecessary procedures, or lying about qualifications and achievements.

The relationship between con-men and medicine is particularly troubling because it undermines the trust that is fundamental to the doctor-patient relationship. Medicine is a field that requires a high degree of trust, both from patients who rely on their doctors for life-saving treatments and from the broader community that expects medical professionals to adhere to ethical standards. When a con-man infiltrates this field, the consequences can be devastating, leading not only to the erosion of public trust and damage to the reputation of the medical profession and institutions but also loss of life and deep psychological trauma for victims and their families.

Con-men in medicine are often able to exploit the inherent vulnerabilities in the health care system, such as the complexity of medical knowledge and the emotional and financial stakes involved in health care decisions. They may use their charm and intelligence to gain the confidence of colleagues and patients, and they can be remarkably adept at manipulating systems to their advantage. This makes it all the more important for medical institutions to have robust oversight mechanisms and for the medical community to remain vigilant against unethical and unprofessional behavior and substandard practice.

For instance, during Swango’s residency at Ohio State University (OSU), several patients under his care experienced unexplained complications and deaths. Despite suspicions and investigations, the university did not initially take decisive action. Swango completed his internship but was not invited to stay on for his neurosurgery residency. His eventual conviction led to recriminations at OSU. Law school dean James Meeks investigated the university’s handling of Swango, and in a sharply worded report, Meeks concluded the hospital’s inquiry was “far too superficial.” Meeks’ review served as a wake-up call for the medical community, emphasizing the need for mechanisms to address potential criminal activities within health care settings promptly.

Many scholars since then have recognized that the field of medicine, with its hierarchical structures and reverence for authority, can provide fertile ground for con-men. The culture of deference to senior physicians and the assumption of competence based on credentials can allow con-men to thrive. Their presence in the profession serves as a cautionary tale about the dangers of unchecked power and the importance of monitoring for imbalances. While medical con-men are outliers, their impact is overwhelming, underscoring the need for systems of accountability and the cultivation of a medical culture that prioritizes ethics and competence over ego and greed.

Arthur Lazarus is a former Doximity Fellow, a member of the editorial board of the American Association for Physician Leadership, and an adjunct professor of psychiatry at the Lewis Katz School of Medicine at Temple University in Philadelphia, PA. He is the author of several books on narrative medicine, including Medicine on Fire: A Narrative Travelogue and Narrative Medicine: Harnessing the Power of Storytelling through Essays.