The Scandal

When the first installment of the three-part documentary series entitled “The Experiments”Footnote 1 (Lindquist 2016a) was aired on Swedish national television on January 13, 2016, it marked the beginning of the public unraveling of one of the greatest scientific scandals in the history of the country. Paolo Macchiarini, a “superstar surgeon” recruited to Karolinska Institutet (KI) and Karolinska University Hospital in 2010, who performed the world’s first transplant of a synthetic trachea in June, 2011, was accused of gross scientific and clinical misconduct. Not only had the numerous transplants since 2011 (including the first one) failed, causing terrible suffering and the premature deaths of severalFootnote 2 patients, but the procedure was also misleadingly represented as the patients’ last resort (McCook 2016). Although they were all very ill, none of the three patients on whom Macchiarini operated in Sweden were in immediate mortal danger (Hawkes 2016). There were no results from experiments on lab animals that used the specific techniques employed in the operations. The legally mandated ethical approval for clinical research had not been obtained. Moreover, the articles published on the procedures contained “fabricated and distorted descriptions of the patients’ conditions before and after the operations” (KI2018). When Macchiarini’s contract at Karolinska University Hospital was terminated in November 2013, after the “unfavourable results and other circumstances surrounding the surgical procedures became clear to clinic and hospital management” (Asplund 2016, p. 4), he continued to perform transplantations at a hospital in Krasnodar, Russia. According to Bosse Lindquist, the journalist who had produced the documentary, the vice chancellor and the rest of the management at KI knew of Macchiarini’s continued activities (Svahn 2016). But most scandalous of all was that the KI leadership had been warned about Macchiarini as early as 2010. Senior management had pushed through the recruit despite the strikingly negative references provided to them, including strong indications that there were serious doubts regarding the soundness of his work, and information suggesting that his CV contained falsehoods. Macchiarini’s contract with KI was extended in 2013 and 2015 without any proper evaluation. From 2014 on, whistleblowers were consistently ignored and even silenced by KI management.

Despite the difficulty of the subject matter and the scale of the scandal, Bosse Lindquist and his team succeeded in providing the public with an understanding of the complex world of regenerative medicine as well as a revealing overview of the course of events up until January 2016. Supported by a highly capable editorial team, and with access both to Macchiarini (because of his love of the spotlight) and to his patients and their families, the reporters investigating the events at the time probably had a better understanding of the situation than Macchiarini himself.

Naturally, the documentary caused quite a stir. Public trust in KI plummeted, and a series of resignations followed in February 2016, including the vice-chancellor and the dean of research at KI. The Secretary General of the Nobel Assembly at KI, which appoints the Nobel laureates in Physiology or Medicine, also resigned in February. Citing the scandal as his reason, the chairman of KI’s university board resigned that September. The entire university board of trustees was dismissed by the Minister for Higher Education and Research shortly thereafter. The vice chancellor of KI at the time of Macchiarini’s recruitment, was dismissed both as university chancellor and as director of the Swedish Higher Education Authority. Macchiarini himself was sacked on March 23. In June 2016, a Swedish prosecutor opened an investigation into his surgical practices, on suspicion of involuntary manslaughter and causing grievous bodily harm. To the surprise of many, not least Bosse Lindquist and his colleagues, in October 2017, the prosecutor announced that she was closing the investigation because she was unable to prove that any crimes had been committed.

Academic Norms

How could a scandal of such proportions occur at one of the world’s most prestigious medical universities? A number of investigations were conducted into the affair, and, to date, hundreds of newspaper articles have been published on it. There are as of now four books having to do with the scandal (Sundberg 2016; Lindquist 2018; Leijonborg 2018; Wallberg-Henriksson and Appelqvist 2019), and it even inspired a play (Lagercrantz 2017). Many commentators attributed the scandal to Machiarini’s personality—the charismatic careerist willing to ignore ethics, break laws and defy basic human decency in order to attain his goals. Others emphasized his compulsive lying, as exposed in Vanity Fair’s story about how the US television news producer Benita Alexander, who fell for Macchiarini while filming a documentary about him, was lead to believe that Vladimir Putin, the Obamas, and the Clintons were planning to attend their upcoming wedding ceremony at which the Pope would be presiding (Ciralsky 2016). Still others, especially the investigators, focused on Macchiarini’s research and procedures, and/or the administrative aspects of KI’s handling of Macchiarini and his research activities (Asplund 2016; Heckscher et al. 2016a, b). The rather narrow focus on either Macchiarini himself or on KI’s administrative failure—its nonchalant and irresponsible attitude towards regulations and other formalities—is only a part of a broader picture. One is given the impression that many of those involved or affected, directly or indirectly, were inclined to frame the scandal as a spectacular deviation from the normal state of things. An editorial in Nature (2016), for instance, described the scandal as “a valuable lesson for the Karolinska Institute”. Any contextual explanations such as, for example, increased government pressure on medical research to move from bench to bedside as fast as possible, were dismissed out of hand: “most institutions don’t respond to such pressures in this way”. Just nine months after the documentary was aired, Nature observed KI’s “exemplary approach to the scandal” and was content that they had already “fine-tuned many of their procedures, including those for recruitment and handling whistle-blowers”. According to Nature, KI should not tighten its procedures too much, so that it “no longer feels comfortable taking justifiable scientific risks”: “the world of biomedicine might yet forgive KI this one major slip,” but “it will not forgive a slip into mediocrity.”

One of the investigations initiated by KI itself (focusing only on the administrative aspects, and not on science or medicine) touched upon possible structural explanations to the scandal. The external investigators briefly mentioned that research policy in the last few decades has increasingly emphasized the need for investments in excellence, and that government committee inquiries as well as research budgets have certainly stressed the need for recruitment of prominent researchers from abroad. “A growing fixation on excellence”, the investigators summarize, “may have had impact on the course of events” (Heckscher et al. 2016b, p. 8). These structural explanations were only mentioned in the passing, however, in one paragraph of the 200-page report.

Unlike the investigations initiated by KI and the Karolinska University Hospital, numerous op-ed articles published in the wake of the scandal pointed to factors that made the recruitment of “star scientists” both possible and desirable. On these accounts, the questionable recruitment of Macchiarini and the failure to monitor and follow up his activities properly bore witness to structural problems caused by recent and current research fundingpolicies.

One name is mentioned recurrently in the articles: Lars Leijonborg, a politician who was formerly chairman of the Swedish Liberal Party who was Director of the Ministry of Education and Research between 2006 and 2007, and Minister of Higher Education and Research between 2006 and 2009. After leaving politics in 2009, he was appointed chairman of the Swedish Educational Broadcasting Company and the media group Mittmedia. In 2013, he assumed the role as chairman of KI’s university board. Many commentators saw a connection between his past and present careers. An editorial in Sweden’s leading morning newspaper, Dagens Nyheter, for example, made the point that Leijonborg’s ideas about how to govern universities have contributed to giving the vice chancellors autocratic powers, and they have probably also contributed to a cult of genius in academia” (Dagens Nyheter2016).Footnote 3

Global Competitiveness

In 2005, a year before the general election in Sweden, the Liberal Party held its annual congress in Gothenburg. As the election campaign was set in motion, the party leader Lars Leijonborg made several appearances in the media, regularly making use of one of his favorite expressions—“turbo-globalization”—to describe the increasingly fierce global competition between regions and countries. He was likely inspired by the American political commentator Thomas L. Friedman (2005). Friedman’s bestselling book The World Is Flat was published earlier that year, and it argued that a perceptual shift was required for countries and companies as well as for individuals to remain competitive in an increasingly global market. According to Friedman, the world was rapidly “flattening “, i.e. historical and geographic differences between regions and countries were becoming increasingly irrelevant. Leijonborg shared Friedmans conviction that the emerging abilities of developing countries would put pressure on businesses and individuals in the Global North, making rapid change inevitable. In Leijonborg’s view, the key to meeting the challenges arising out of competition with low-cost countries was knowledge (Dagens Industri2005). Higher education and research were thus becoming strategically important. In his speeches, Leijonborg asked “why not make ‘more Nobel Prizes to Sweden’ our election pledge?” (Molin 2005). He was, of course, not alone in promoting the role of universities in the global knowledge and innovation race. The decade after the turn of the millennium saw a growing interest in higher education and research on all political levels, national as well as international.

In April 2005, at about the same time as Friedman published his book, the European Commission published a communication entitled Mobilising the brainpower of Europe: Enabling universities to make their full contribution to the Lisbon Strategy (European Commission2005a). The document identified universities as an indispensable part of the commitment by EU governments to concentrate their efforts on economic renewal. The introduction predicted future developments and pinpointed a challenge:

Within the next 20 years, Europe’s economic paradigm will change fundamentally. Its manufacturing base will continue to shrink, future growth and social welfare will rely increasingly on knowledge-intensive industries and services, and ever more jobs will require a higher education qualification. Yet European universities, motors of the new, knowledge-based paradigm, are not in a position to deliver their full potential contribution to the relaunched Lisbon Strategy. (European Commission2005a, p. 2)

The solution was to “strengthen the three poles of Europe’s knowledge triangle: education, research and innovation”. Obviously, universities are essential to all three and hence “investing more and better in the modernization and quality of universities is a direct investment in the future of Europe and Europeans” (European Commission2005a, p. 2). Mobilizing existing brainpower was not enough, though. To counterbalance the effects of increased global competition, European countries had to become better at attracting the best talent. The attractiveness of higher education institutions is crucial in this regard: “Mindful of these concerns, EU Ministers of Education have already set the objective of transforming the EU into ‘the most-favoured destination of students, scholars and researchers from other world regions’” (European Commission2005b). The strategy to achieve both competitiveness and attractiveness was to push for a transformation of the entire organizational architectonics for funding of research and higher education. In the early 2000s, the EU initiated an ideologically framed large-scale project aimed at the integration of national publicly funded systems. The concept of the “European Research Area” constituted the framework for a rethinking of the rationale for supporting research and the role of higher education and research policy (Nedeva and Wedlin 2015).

The strategies largely revolved around two concepts: autonomy and excellence. While the former was a step towards improving efficiency at the local level by decentralizing power to university managements so that they could profile their institutions, prioritize what areas to invest in and take control over the recruitment of academic staff, the latter was a move towards centralization of national research funding by concentrating investments on certain internationally competitive strategic research areas.

Autonomy and Excellence

In its report Tertiary Education for the Knowledge Society from 2008, the OECD identified less state involvement and more institutional autonomy in higher education as one of the strongest current trends. Some countries had already made reforms to transform universities from state agencies to self-governing legal entities. According to the report, one of the challenges was “finding the proper balance between governmental steering and institutional autonomy” (p. 16), but the main policy was to “give institutions ample autonomy over the management of human resources” (p. 17). Increased flexibility in hiring and firing was just one of the many options the OECD wanted to review in order to “widen the scope of institutional autonomy so as to allow for greater responsiveness (to students, stakeholders, regions) and efficiency in operations” (p. 18).

While the OECD’s “Pointers for future policy development” were somewhat cautious, the EU was more straightforward about the alleged need for institutional reforms towards greater autonomy. The EU Commission made it clear that “[u]niversities will not become innovative and responsive to change unless they are given real autonomy and accountability” (European Commission2006, p. 5). New internal governance systems based on “strategic priorities and on professional management of human resources, investment and administrative procedures” were required. The aim was to overcome the universities’ “fragmentation into faculties, departments, laboratories and administrative units” and to “target their efforts collectively on institutional priorities for research, teaching and services”. To achieve this, the member states were advised to build up and reward management and leadership capacity within its universities, for example, by “setting up national bodies dedicated to university management and leadership training, which could learn from those already existing”. Furthermore, to improve their competitiveness, European universities must be given “autonomy to position themselves, cooperate and compete at European and international levels, and better link their research activities to the needs of industry and society” (European Commission2007, p. 14). In 2007, things were looking promising: autonomyreforms were under way in many countries. These reforms needed to be completed “and extended to the whole of Europe”.

As Minister of Higher Education and Research in the government that took office in 2006, Leijonborg was swift to take action in line with the OECD’s and the EU’s strategies. In 2008, he submitted a comprehensive government bill entitled A Boost for Research andInnovation (Prop. 2008/09:50) to the Swedish Parliament. The bill was based on proposals presented by several commissions of inquiry between 2005 and 2008, some of which had been initiated by the previous Social Democrat government (there was then and remains today a broad consensus across the spectrum of Swedish political parties on these issues). Four of these official reports are especially interesting with regard to the ambition of enhancing Sweden’s competitiveness by mobilizing universities.

The report Resources for Quality concerns funding for research and higher education in Sweden. Changes had to be made so as to move from a consolidated higher education system with an emphasis on “classic universities” towards profiling and differentiation: “In the university landscape of the future, the Inquiry wants to see a diverse range of higher education institutions with a higher degree of independence” (SOU 2007:81, p. 25). The report recommends that Swedish universities develop individual profiles and set new priorities to a greater extent than was the case, in order to concentrate education and research on their strengths, where they are best placed to compete successfully internationally.

The commission of inquiry behind the report Careers for Quality proposed improvements to the current academic employment structure—the appointment procedures at higher education institutions in Sweden needed to be more streamlined. According to the report, the existing rules of employment in general (regulations aimed at ensuring accountability and impartiality in the state administration), and the requirement for external expert reviews of candidates in particular, were too time consuming and rigid: “In a globalized world where knowledge as well as competition knows no boundaries; where the ability to attract and to keep talent is crucial for success, the current recruitment process causes problems” (SOU 2007:98, p. 246). The solution was to reduce the number of central regulations and thus increase university autonomy by granting them more local self-determination.

According to the official report World Class!—Action Plan for Clinical Research, Sweden has clear competitive advantages over other countries, e.g. high levels of education, assets in the form of public health data registers, national healthcare quality registries and biobanks, and patients who willingly take part in research projects. Sweden also has a long tradition in clinical research which, for many years, contributed to the strong position of the Swedish medical industry today. “All this adds up to competitive advantages that many other countries do not have”, the report stated, concluding that “Swedish clinical research should therefore not be satisfied with being good enough—it has the potential to be world class!” (SOU 2008:7, pp. 20–21). In order to achieve this goal, it was necessary to “change tactics”. The key to success was “the ability to identify the best researchers, give them good opportunities to carry on their activities and achieve good results” (SOU 2008:7, p. 21). Fewer, but larger, grants should go to the best researchers so as to optimize the outcome of publicly funded research.

ResearchFunding—Qualityand Relevance echoing many of the ideas in these reports, it emphasized the need for better strategic coordination of research funding at the national level. According to the report, the existing funding structure was too fragmented. In order to achieve excellence and global competitiveness, funds should be concentrated on certain successful research areas. The aim of the new funding structure was to ensure that limited resources would be invested where they produced maximal output and best contribute to “the creation of excellent research environments, cutting-edge research, and increased commercialization of research outputs” (SOU 2008:30, p. 172).

Many of the reports that formed the basis for Leijonborg’s government bill cite both OECD recommendations and EU communications as well as different kinds of rankings. The outlook is international, and the reports convey a sense of urgency in meeting the challenges posed by a rapidly globalizing world. Sweden’s future welfare depends on the organization and funding of research and higher education, it was argued, because they are what give the country a competitive edge in the global quest for talent, innovation and prestige. On the one hand, the reports advocated decentralization, i.e. more flexibility and institutional autonomy with regard to faculty recruitment and research profile. On the other hand, they argued for centralized control over the distribution of research funding to ensure the highest possible return on investment. The tendency to centralize and decentralize at one and the same time was especially evident in two reforms initiated and/or undersigned by Leijonborg: the establishment of Strategic Research Areas and the Autonomy Reform.

Between 2010 and 2014, the Swedish government established 43 Strategic Research Areas aimed at developing internationally prominent research environments to solve key social issues (as defined by bureaucrats and politicians) in a long-term perspective. The ideas behind the AutonomyReform were first introduced in a committee report entitled Independent seats of learning (SOU 2008:104) that proposed all public Swedish higher education facilities be classified and constituted as legal persons rather than government agencies. Many considered the proposal too radical, and the Ministry of Education further revised the proposal. A year later, in 2009, the government issued a new bill that proposed that Swedish universities remain government agencies but with substantially increased autonomy. The Autonomy Reform was implemented in 2011.

Both the Strategic Research Areas and the Autonomy Reform have been criticized. The Strategic Research Areas were faulted with promoting competition between universities at the expense of collaboration and concentrating public resources for research funding to a few universities and research areas. The Autonomy Reform has been shown to undermine collegial bodies as a consequence of the deregulation of the internal organization of higher education institutions. Before 2011, the law stipulated that all higher education institutions must have at least one faculty board consisting of faculty and student representatives with discretionary powers with respect to issues involving the quality and content of educational programs and research. The new law softened the requirement, stating simply that academic matters be decided by academically qualified faculty (Sahlin and Eriksson-Zetterquist 2016), which gave vice chancellors enhanced discretionary powers with regard to the internal organization and positions of his or her institution. A wave of reorganization followed the deregulation in 2011, resulting in a replacement of collegial organizational structures with managerial forms of governance and control (Sundberg 2013, 2014).

With few exceptions (faculty at remaining collegially governed universities in Uppsala, Stockholm and Lund), the reforms have met relatively little resistance—even by Swedish standards. As the Macchiarini scandal erupted, however, many critics cited the reforms as factors contributing of the catastrophe. There seemed to be a pent-up frustration among faculty that now found a much-needed outlet.

Accountability

One of the earliest critics of the Autonomy Reform was playwright and television producer Ylva Lööf, who wrote the aforementioned play inspired by the Macchiarini scandal. In an op-ed article published in Dagens Nyheter in November 2008, two years before Macchiarini was recruited, she urged Leijonborg to stop the proposed reform, especially the proposed removal of the requirement for external independent experts in faculty recruitment. Having taught courses in university pedagogics for faculty at KI for 14 years, Lööf had ample occasion to observe the effects of nepotism. Her article in Dagens Nyheter presented three clear cases of flawed recruitment processes in which KI faculty had manipulated the recruitment process so as to ensure that a favored but less qualified applicant was awarded a position. Lööf warned that the Autonomy Reform would open the floodgates for this kind of cronyism: “having the right connections would become even more decisive for career opportunities” (Lööf 2008). Looking back at the scandal in an interview in 2019, Lööf said that “Leijonborg’s reform paved the way for it, long before Macchiarini was hired at KI” (Beeck 2019). She described a culture at KI in which it was common to decide who would get a professorship in advance of the recruitment process and regardless of the qualifications of the applicants. “This is why the Autonomy reform is so upsetting”, writes Lööf in another retrospective article, “it legalized this corrupt behavior” (Lööf 2017). Torbjörn Tännsjö, a professor of ethics and prominent public intellectual in Sweden, argued along the same lines when he described the derailed elitist atmosphere at KI. The problem, in his view, was that “KI has been dazzled by the Nobel prize and lacks academic culture” (Tännsjö 2016).

In the op-ed article “Leijonborg’s reforms paved the way for the catastrophe” (Carlsson et al. 2016), three highly respected Gothenburg University faculty, Nobel Prize winner (2000) Arvid Carlsson, Elias Eriksson, both in pharmacology, and Kristoffer Hellstrand (tumor immunology) described the consequences of the establishment of Strategic Research Areas: “The unfortunate competition for mega grants that Minister of Education, Leijonborg, introduced contributed to the catastrophe that KI Board of Trustees chairman, Leijonborg, now has to deal with.” Instead of focusing on errors committed by KI officials, we should “analyze the political decisions that made this catastrophe possible in the first place”. In particular, they noted Leijonborg’s idea that concentrating resources to a few “excellent” research environments would lead to more Swedish Nobel Prizes and higher global rankings for Swedish universities. The problem, according to Carlsson et al., was that even though more funding was made available for research, the control over its distribution became even more centralized. The idea of allocating more public funding to a few selected research areas in order to recruit international star researchers to Sweden reminded them of “Russian oligarchs who use their oil money to transform mediocre football teams into champions”.

Although their criticism was directed at the Strategic Research Areas, Carlson et al. also questioned the Autonomy Reform: “Was it really wise to abandon collegial forms of governance and introduce line management, inspired by the corporate world, at Swedish seats of higher learning?” They were convinced that “this tragedy could have been avoided if traditional academic forms of governance would have remained in place.” Leijonborg and the previous government were blamed for drastically lowering the quality of the decision-making at Swedish universities, “by concentrating almost all the power to wannabe CEO vice-chancellors monitored only by university boards of trustees dominated by laymen too ignorant of academic conditions to be able to exercise any real balancing influence.”

Political Scientists Li Bennich Björkman and Shirin Ahlbäck Öberg have also linked both the Strategic Research Areas and the Autonomy Reform to the Macchiarini scandal, calling it a catastrophe, one owing much to the cronyism among a handful of professors at KI, but also to Leijonborg’s pursuit of international star quality in recruitments which, together with the investment in Strategic Research Areas, “paved the way for really poor judgement” (Bennich-Björkman and Ahlbäck Öberg 2016). The ignorance of the “politico-research complex” and its overconfidence in management models from business threatens to undermine academic culture as a whole. Line management, groupthink and fear are corroding academic environments throughout the Swedish higher education landscape (see also Ahlbäck Öberg et al. 2016).

Together with Ulf Danielsson, professor of theoretical physics at Uppsala University, Ahlbäck Öberg wrote another op-ed article, in which they argued that the Macchiarini case demonstrated clearly the consequences of dismantling collegial governance structures. When the discretionary powers of the vice chancellor are so expanded as to enable him or her to ignore or even stifle whistleblowers or external investigators, collegial control systems can no longer prevent disasters like this one from happening. “What we are witnessing”, conclude Ahlbäck Öberg and Danielsson, “is the result of a politically generated system failure that risks destroying one of our most important societal institutions” (Ahlbäck Öberg and Danielsson 2016).

According to Czarniawska (2015, p. 38), the Autonomy Reform demonstrated in full sociologist Peter Blau’s (1970) observation that “the decentralization of large bureaucracies results in power shifting only one level down”. Many vice chancellors used their newly found “autonomy” to take control over research and teaching by formulating overarching visions and profiles for their institutions. The next logical step was reorganization. Such reorganizing meant a shift away from traditional collegial governance over curricula and research towards a line organization in which every section could be assessed in light of institutional mission statements. Thus, for instance, the academic quality and value of work done in certain disciplines, especially in the humanities and the social sciences, is quite irrelevant, if it’s the “wrong” kind of research in relation to the institution’s overarching profile. A vision, mission or profile enables assessment of incommensurable disciplines that can be used, among other things, to marginalize dissenters among the faculty and staff. At the “corporate” university, traditional academic structures, values and concepts were quickly usurped by the principles and practices of corporate management (Hyvönen 2013).

But perhaps we ought not to attach too much importance to Leijonborg. In many respects, he was just following “a fashion at the state level” (Czarniawska 2015, p. 38) when he introduced reforms similar to initiatives launched throughout the Nordic countries at the time. Leijonborg was a vehicle for the New Public Management trend that then held sway. His initiatives as Minister of Higher Education and Research reflected similar plans formulated elsewhere by others, especially the OECD and the EU. According to Löwdin (2010), Leijonborg seemed almost clueless about the inner workings of academia. Rather than liberating the universities from government control, which appears to be what he thought he was doing, his reforms lead to severely reduced faculty autonomy. Leijonborg was a stranger to the world of research and higher education, and “it often felt as if he was just repeating the words of others without a clue about academic realities” (Löwdin 2010).

In his autobiography, published in 2018, Leijonborg devotes an entire chapter to the Macchiarini scandal, but it is nearly devoid of self-criticism. Even retrospectively, Lejonborg acknowledges no responsibility for what happened, either as minister or as chairman of the KI Board of Trustees.

Rankings unto Death

It is strange to be accused of having done the opposite of what you think you did. (Leijonborg 2018, p. 373)

On the morning of September 22, 2016, seven months after the Macchiarini scandal erupted, Swedish Radio’s news broadcast Ekot reported that KI had been placed 28th in Times Higher Education’s global ranking. The universities in Uppsala and Lund were both ranked within the top 100, and the universities in Stockholm and Gothenburg, together with the Royal Institute of Technology, were ranked as being among the top 200 higher education institutions in the world. “This makes Sweden the fifth best country for higher education in Europe”, the broadcast announced (Samzelius 2016). In an interview after the announcement, the acting Vice Chancellor of KI at the time, Karin Dahlman-Wright, stated that she was very pleased with the ranking, because it proved that KI “has a good reputation”.

Two weeks later, Dagens Nyheter published an op-ed article by Leijonborg (2016) with the heading, “KI’s reputation has been saved by good crisis management”. He cited the Times Higher Education ranking as proof that the handling of the crisis at KI—for which he himself, as chairman of the KI Board of Trustees, was ultimately responsible—had been very successful:

A few months ago, the media reported that KI may fall in the 2016 university rankings. Now that the results of the Times Higher Education ranking have been published, it turns out that KI did not fall at all, but was ranked as the 28th best university in the world—outstanding among Swedish and Nordic universities. [---] In the Shanghai ranking, which was also published recently, KI gained four positions. This is largely due to KI’s handling of the Macchiarini crisis. Since the affair exploded […], much has been done right. (Leijonborg 2016)

Apparently, Leijonborg saw no reason to let the prolonged suffering and premature deaths of vulnerable patients as a result of scientific and clinical misconduct prevent him from patting himself on the back for good crisis management and high rankings. In the op-ed, he expressed concern that the Macchiarini scandal might be used by some to criticize the investments in the Strategic Research Areas and to question the Autonomy Reform, asserting that because “[it] is well-documented that a high degree of autonomy is important for universities,” the factors that have made Swedish research policy so successful must be safeguarded. “We must continue increasing resources for research and protecting the autonomy of the academy” (Leijonborg 2016).

The chapter on the Macchiarini scandal in Leijonborg’s autobiography makes clear his view of the politician’s role vis-à-vis public universities. He compares his Strategic Research Areas initiative to John F. Kennedy’s expansion of the space program, and Richard Nixon’s “war on cancer”. In Leijonborg’s view, such grand projects are too general to pose a threat to the integrity of universities. To the contrary, Leijonborg regards himself as a stalward defender of academic freedom (whatever that term might entail for him). Similarly, he considers himself an ardent champion of collegial decision-making:

There is a lot of confusion about what a collegial body really is. [---] Some say that the Macchiarini scandal could have been avoided with more collegial decision-making. Excuse me? [---] Professors and associate professors, dozens of professors and associate professors—and none other than professors and associate professors—made the decisions that lead to the hiring of Paolo Macchiarini (Leijonborg 2018, pp. 374–375).

It is obvious that Leijonborg is himself confused about the nature of collegial bodies. While it is true that the people responsible for the decision to hire Macchiarini were all medical scientists, they were not acting in their capacity as colleagues but as managers. “We must stand up for collegial decision-making”, Leijonborg writes, but “we should not pretend that it will guarantee that things will not sometimes go very, very wrong…” (Leijonborg 2018, p. 375). He does not see that these decisions were taken by individuals and coteries, not by a collective body of experts exercising their expertise in concert. In a line organization, top management is in control, and the chain of command is clear and simple—managers tell you what to do. The reforms initiated by Leijonborg led to a decline of collegial governance, which was replaced by bureaucratic structures that disfavor cooperation and collective responsibility.

The danger is that without any deeper knowledge about the organization’s core activities, managers are inclined to focus on superficial metrics to evaluate performance. At “autonomous”, corporate universities, academics are “subject to the same accountability and incentives as, say, a call-center worker” (Roelofs and Gallien 2017). Productivity is measured in terms of how many publications are published per year. Quality is measured by citations. This kind of quantification of quality contributes to what Giacalone (2009) has called the problem of “metricality”, i.e. that focus has been redirected from producing quality work (which used to be the assumptions that underpinned academic professionalism) toward “succeeding within a metrics-based reality […] where quality is narrowly and artificially defined” (Giacalone 2009, p. 124).

Leijonborg is not personally responsible for the Macchiarini scandal, but like EU policy-makers, he certainly helped create the conditions that made it possible. The shared sense of urgency to meet the challenges of a rapidly globalizing world, led to a “silent regime change” (Hellquist 2016)—plans and strategies were formulated with the aim of universities more like corporations, which in turn undermined professional judgment. The logic of these ideas is as simple as it is clear: Organizations cannot be efficiently managed if the employees have too much control. To really run universities efficaciously, new funding and management models had to be implemented at all costs, which turned out to be at the expense of students and faculty of universities throughout Europe. But Macchiarini’s patients paid the ultimate price.