Incidences of serious scientific misconduct within the academy should prompt rigorous self-reflection among all involved parties. Yet as Berggren and Karabag explain when analyzing the case study of misconduct at the Karolinska Institute in Sweden, market-oriented institutional logics (or belief systems that are taken for granted as truth) create a context where branding and image concerns carry more weight than the rigour typically associated with peer-review, or the ‘do no harm’ mantra affiliated with the medical profession. The results, when paired with a fragmented system of control between academic institutions and academic journals, can be deadly.
Berggren and Karabag delve into detail when discussing the misconduct scandal at Karolinska Institute. A renowned surgeon, Pablo Macchiarini, claimed to have developed an innovative approach to tracheal transplants and organ regeneration and published several articles in prestigious journals like The Lancet. Other doctors involved in the post-surgical care of his patients, however, found serious issues with his work, and six of the eight patients Macchiarini operated on passed away. Despite these doctors raising their concerns with Macchiarini’s work, the Karolinska Institute protected Macchiarini until he was exposed in 2016 by a documentary film broadcast in Sweden that prompted a public inquiry.
A core issue that arises from this case study is the ways in which dissenting voices are silenced in the academy by the prospect of fame, innovation and research funding. Macchiarini was able to get 15 co-authors at Karolinska to endorse the erroneous “proof-of-concept” paper that garnered his methods such fame. These co-authors should have indicated that the paper was scrutinized and highly vetted. Instead, because of a highly competitive workplace culture that rewards researchers on fixed-term contracts who publish extensively, none of the co-authors made critical comments in internal seminars designed to scrutinize the scientific basis for the paper. The dissenting doctors did not have any of the renown of Macchiarini, and thus had little capacity to expose his misconduct inside or outside of the academy. Moreover, these dissenting doctors were vastly outnumbered by the co-authors that had significant investment in the success of the research, and were thus ignored or marginalized by the Karolinska Institute.
These institutional failures were compounded by a fragmented system of control and responsibility for scientific rigour between journals and academic institutions. Institutions outsource the responsibility of review and propriety to journals, who are now also governed by market-oriented logics and thus often perceive academic institutions to be responsible for ensuring academic rigour. The New England Journal of Medicine, for instance, rejected Macchiarini’s paper based on the lack of data from animal studies proving its efficacy – upholding the standard of academic rigour. The Lancet, on the other hand, not only accepted Macchiarini’s papers, but ironically claimed that they needed to see ‘hard evidence’ that his findings were erroneous before they were able to retract his paper. Part of the basis for The Lancet’s lack of rigour is their rapid acceptance model – the paper was accepted less than a month after submission. As of the time of Berggren and Karabag’s writing, the paper had still not been retracted, and remained on The Lancet’s website.
Berggren and Karabag highlight an important flaw in the process of using metrics like notoriety and research to determine the worth of scientific work. The competing institutional logics of academic rigour and medical care were ultimately successful in this case, but they had to be upheld by people outside of the institution who were not subject to the prevailing market-oriented logic. They suggest that, moving forward, the academy could learn a lesson from the sports world, where doping scandals prompted the creation of the World Anti Doping Agency which has a mandate to root out misconduct. While that would be too late for the people affected by this scandal, it would be a much needed safeguard in the future.
See: Berggren, C., & Karabag, S. F. (2018). Scientific misconduct at an elite medical institute: The role of competing institutional logics and fragmented control. Research Policy. https://doi.org/10.1016/j.respol.2018.03.020
Photo credit: Jaluj. Moyano Hospital at Buenos Aires