What causes ethical breakdowns?

What causes ethical breakdowns?

No one could have missed the turbulence created around Paolo Macchiarini, the research on the artificial trachea, the horrific surgery on healthy patients and the far reaching consequences for the reputation of Karolinska Institutet and the Karolinska University Hospital.

I am not blaming any particular person for the handling of this scandal. I am just writing a short reflection on how this situation could occur in a professional research- and clinical environment.

A strong CV with research published in the “best” scientific journals is usually correlated with the size of funding and the possibility for a higher and more prestigious academic position. However, problems arise when
• the written CV is not correct (this was obviously the situation in the Macchiarini-case)
• the evaluation of a described research potential and credibility is not performed in a right way (which was apparently also true in the Macchiarini-case)
• the research data is not presented in a correct way (which has happened in the Macchiarini-case)
• the interest from the university point of view for supporting a person or a scientific niche, is entirely resting on economic incentives

In the latter case I miss pure facts in the particular Macchiarini-case. However one thing is certain, in addition to false information regarding former positions in his CV, no top-of-the-line publications was achieved by Macchiarini at the time he was hired to Karolinska Institutet. This is not to be expected for a “star”-recruitment.

There is no doubt that KI should perform top research, but at a university, no matter how prestigious, there must be time for reflection. However, the eagerness and prospects to earn money risk to transforming the academic tradition with free thoughts into an economic affair. In an environment where economic matters increasingly are occupying the minds of researchers, it is easier to understand the temptation to turn a blind eye to ethical considerations for the sake of tens of millions Swedish crowns.

In the current case perhaps the following question is the most central: how could anyone (in a highly advanced research environment) believe in achieving fully functional trachea tissues, with natural blood vessels and immune system, mucous membranes, active cilia etc. after incubating a plastic tube in a bath containing stem-cells from bone marrow, and under the constant exposure to microbes? Let the Macchiarini case go down in history as another warning example of when one person managed to manipulate a handful “clever” colleagues and funding institutions with unrealistic promises of an extraordinary future for regenerative medicine, based on hope but without solid facts. There are no shortcuts in biology.

In all the criticism that has smeared the reputation of Karolinska Institutet, I feel great sympathy for all clever researchers in the field of regenerative medicine present at KI.

Tomas Ekström
Professor, Group leader Medical Genetics