NEWS Carelessness regarding rules, groupthink and a culture of secrecy are some of the explanations as to why the so-called Macchiarini case at Karolinska Institutet and the Karolinska University Hospital had such dire consequences. This according to Kjell Asplund, professor emeritus at Umeå University, who analysed the events.
Kjell Asplund. Photo: Mattias Pettersson.
In conjunction with this week’s board meeting at Umeå University, Kjell Asplund presented the most important conclusions of his independent investigation of Paolo Macchiarini’s synthetic trachea transplants at the Karolinska University Hospital. Kjell Asplund also has great knowledge of the events at Karolinska Institutet that are interlinked in many ways.
The investigation states that Paolo Macchiarini, among many other, was hired very haphazardly, both at Karolinska Institutet and the University Hospital, simply by breaking the established rules for employment. For instance, no interviews were held with Macchiarini and no consideration was put on the negative references that they had received.
Furthermore, the impression of responsibility was varying, where it was unclear what parts were covered by health care and research respectively. Kjell Asplund considers that several of the surgical operations conducted at the Karolinska University Hospital rather should be categorised as research than health care and should hence have been subjected to ethical review before commencing.
“In general, it is clear that both the University Hospital and Karolinska Institutet have had a very relaxed attitude to existing rules and regulations. They show a lack of respect, quite frankly. And I fear that the same problem is present be found at other universities. That’s why the probably most important measure is to increase knowledge of rules within the organisation and also influence attitudes in order for rules to be complied with. Regardless of people’s opinions of rules and regulations, they have been established to protect patients. This case shows all too clearly what carelessness regarding rules can result in,” says Kjell Asplund.
However, he also states that lack of respect with regards to rules is not the only problem. In his investigation, he made sixty interviews that show a clear streak of groupthink, in which the desire for harmony or conformity in the group results in an irrational or dysfunctional decision-making outcome. The involved parties did not question controversial decisions being made, at the same time as Paolo Macchiarini was seen as an important visionary, charismatic and convincing person.
“If you want to be at the forefront of international research, it’s easy to start accepting news and messages instead of questioning them. The strong competition that means people with critical opinions put their careers at risk, may also have contributed to a culture of silence and secrecy both at the hospital and at the university, which further amplifies the problem of groupthink,” says Kjell Asplund.
He describes the present situation at the Karolinska University Hospital and Karolinska Institutet as strongly influenced by the Macchiarini case. Many members of staff have suffered and certain groupings show an apparent irreconcilability to one another.
“Since these members of staff need to collaborate after all, this has become a question of working environment that requires measures from the employer. I have talked about a need for reconciliation,” says Kjell Asplund.
On the question if Macchiarini is an exception, or if it can happen again, maybe somewhere else, Kjell Asplund’s answer is as clear as glass.
“This type of event can not only happen again, but it will. That’s why it’s so important to discuss this case, develop ways of discovering deviations from what is acceptable and also take preventive measures to restore trust for clinical research,” says Kjell Asplund.
Hans Adolfsson, Vice-Chancellor of Umeå University, reckons the Macchiarini case and especially the investigations of the case at the Karolinska University Hospital and Karolinska Institutet conducted by Kjell Asplund and Sten Heckscher puts the finger on important questions that concern the entire scientific field.
“Since the mechanisms behind the events are very general, there is always a breeding ground for developing unhealthy environments and attitudes also at other higher education institutions. These are events that universities around the country need to learn from. How we should prevent events of this kind needs to be discussed further, but as I see it, continuous education regarding attitudes to rules and regulations, preferably on a national scale, to ensure development that is healthy.” says Hans Adolfsson.
Editor: Anna Lawrence