Karolinska sharply criticised in enquiry into Macchiarini misconduct case

The fallout from the scientific scandal centred on disgraced surgeon Paolo Macchiarini has intensified this week, with a fresh round of resignations and firings, and attention turning to leadership inadequacies at Karolinska Institutet (KI), where warnings about the Italian’s controversial operations were not treated seriously enough.

A new investigation published on Monday by an independent commission sharply criticises the university for not properly looking into Macchiarini’s background before hiring him, despite warnings from previous employers.

Hans Wigzell, a cancer immunologist and vice-chancellor of Karolinska from 1995 to 2003, said he does not believe it has anything to do with systemic procedural flaws at the university.

“Politicians frequently believe the system is to blame. But it was people who were just not up to the job. The continuous support given to Macchiarini by decision-makers was unfortunate and hard to understand,” he said.

The first mistake, according to Wigzell, was committed by Harriet Wallberg, who was vice-chancellor of the university when Macchiarini was hired without completing a job interview in 2010. 

“She was too actively involved in his recruitment,” he said. “The process got deformed after that, even while there were warnings coming in saying ‘don’t take this guy’. When your vice-chancellor is involved, people below kind of became a bit looser at following the rules.”

The allegations against Macchiarini at the time were that he provided incorrect information in his CV and questionable data in his publications.

“I’ve never seen such negative references,” said Sten Heckscher, former president and justice of the Supreme Administrative Court of Sweden and lead investigator on the report released on 5 September. “It’s quite remarkable that the vice-chancellor didn’t have the matter probed more extensively.”

The report says KI had “nonchalant attitude towards regulations". It also says that Macchiarini’s initial appointment in 2010 “was pushed through inappropriately”.

A bunker at the top

Wallberg and her successor Anders Hamsten were this week both asked to leave a panel which picks the Nobel winner in Physiology or Medicine.

Wigzell says both were inaccessible leaders.  

“When I was in the job I kept an open door. You need to be readily accessible, but there were significant steps from top management coming after me to shield themselves from people. It became more difficult to contact them – a potentially lethal flaw if you want to run a complex organisation,” he said.

This became especially true in the last months of Hamsten´s stay when it was discussed among KI workers that there was now “an inaccessible bunker at the top of KI”.

Both Wallberg and Hamsten have not responded to a request for comment.

Hamsten stepped down from his role as KI’s vice-chancellor in February when the university announced it was reopening an investigating into research misconduct by Macchiarini, who was still employed at the time.

An internal probe into Macchiarini’s work cleared him of research misconduct in 2015. KI extended his contracts in 2013 and 2015, even after the university hospital, where he also worked, had terminated its contract with the surgeon.

Bengt Gerdin, a retired professor of surgery at Uppsala University in Sweden commissioned by KI in 2014 to look into allegations against Macchiarini, is more sympathetic to KI management.

“It’s no shame to be seduced by a very intelligent scientist,” he said. His conclusion is that internal systems, rather than people, were found wanting at KI. “In universities there must be routines to identify people like Macchiarini and limit the damage they can cause,” said Gerdin.

He has sympathy for Hamsted, who became vice-chancellor in 2013. “He inherited the problem of Macchiarini. My feeling, having interviewed him, is that he first believed it was not as bad as it was. He felt some of the stories surrounding Macchiarini were being fabricated. I don’t think he really did understand the scale of the problem.”

Macchiarini, once regarded as a pioneer in the use of stem cells in regenerative surgery, came to KI two years after he was part of a team that carried out the first windpipe transplant partly made of the patient's stem cells. That operation involved the use of a donor trachea. However, Macchiarini later pioneered the use of bioplastic implants seeded with the patient’s stem cells.

Of the three artificial-trachea transplants he carried out at Karolinska hospital between 2011 and 2012, two of the patients have since died, and the third remains hospitalised.

He lost his job in March after a documentary by Swedish journalists aired with footage of his controversial operations and is now being investigated for two cases of involuntary manslaughter. He has denied all the charges against him.

After the documentary, several leading Karolinska figures resigned, including the vice-chancellor, the dean of research and the secretary-general of the Nobel Assembly. Remaining KI board members who were active during Macchiarini’s tenure are to be replaced.

Reputational damage

While the scandal has reverberated around Swedish academia and dealt a severe blow to KI, which carries out 40 per cent of Sweden’s medical research, Gerdin does not think it will have lasting reputational damage.

“I don’t think it will have a long-lasting impact on Swedish science, no,” he said. “But there’s an awakening here; an acknowledgement that it could have happened anywhere.”

Acting vice-chancellor of the KI, Karin Dahlman-Wright, said in a statement on the KI inquiry results, "It is now up to us to show that KI is so much more than just the Macchiarini case.” KI has tightened up its procedures for recruitment and handling allegations of scientific misconduct, she said.

Wigzell believes the decision this week to fire the KI board en masse was a mistake. There’s a vacuum at the top of the university now just when leadership is needed most,” he said.