The eyes of the world are on the Karolinska Institute in Stockholm this week for the announcement of the Nobel prize in medicine, but an ugly medical scandal lurks in the background. The case of Paolo Macchiarini involved the deaths of multiple patients and several instances of research fraud, and has exposed the misdeeds of a single professor. But it also demonstrates the risks of academic capitalism: a global trend that turns universities into businesses. In this respect, the story has wider lessons for us all.

As academic capitalism spreads, universities abandon traditional meritocratic and collegial governance to hunt money, prestige and a stronger brand. Here in Sweden, this shift has been especially profound: since the 1980s, the university system has been deregulated, and its core principles gradually replaced by management practices from the corporate world. Government research policy over the past decade has further pushed universities to centralize their strategic management and increase their international visibility. Major strategic funding programmes included one to recruit international star scientists.

An investigation into the Macchiarini scandal, led by a former president of the Supreme Administrative Court of Sweden, Sten Heckscher, delivered its report last month, and puts some blame on this “new orientation of research policy”. There is now an elevated risk that fraud is not properly detected and that ethically doubtful research is allowed to continue, notes the report, because new policy incentives cloud the judgement of academic leaders.

The Heckscher investigation shows how officials at the Karolinska Institute (KI) contributed to the scandal. In their efforts to recruit Macchiarini in 2010, and in their handling of the renewal of his contract and the allegations against him in 2011–15, university leaders short-circuited regulations and established practices. They failed to have Macchiarini’s research properly peer-reviewed, and ignored both allegations of research fraud and the results of external investigations.

From the outside, it seems that KI officials were tempted by the prospect that Macchiarini would revolutionize regenerative medicine and thus bring great prestige and worldwide acclaim. Already placed highest among Swedish universities on global ranking lists, the KI no doubt saw a chance to distinguish itself further and attract more funding and prestige, in an endless hunt for greater acclaim.

Yet this conduct goes against fundamental values of academia — the careful scrutiny of all claims, and of the research (and teaching) portfolios of those making such claims. This core principle in the self-organization of the academic system (studied by sociologists Robert Merton and Pierre Bourdieu, among others) is intended to guarantee that science progresses and delivers knowledge and technology to society that is as accurate as possible and not gained unethically.

“Academic self-regulation and vocational autonomy are replaced with control by audit and management.”

Academic capitalism runs counter to these ideals, subsuming achievement in research and teaching to attainment of economic goals and quantitatively oriented (and shallow) performance assessments and rankings. Academic self-regulation and vocational autonomy are replaced with external control by audit and management. The individual’s struggle for recognition in science is colonized by university managers, who use the achievements of scientists and students to accumulate capital (economic, symbolic and cultural, in Bourdieu’s terms), and thus increase the visibility of their university.

As Heckscher’s investigation shows, the intervention of the KI’s then rector, Anders Hamsten, in the renewal of Macchiarini’s contract with the university in 2015 led to the arbitrary acquittal of Macchiarini from accusations of scientific fraud in the same year. Thus acts an academic leader who has abandoned sound academic practice in favour of maximizing the prestige and finances of his university. An academic leader remaining true to the classic ideals, and embedded in a sound academic culture and research policy, would have made the obvious choice to investigate the fraud allegations thoroughly at an early stage, looking beyond the count of publications and grants that is standard for performance appraisal today.

This strategy would have been risk-free. If the investigation had cleared Macchiarini’s name, every­one would have benefited — the KI, the Karolinska University Hospital, Hamsten, Macchiarini, Swedish advanced clinical treatment, the international community of regenerative medicine and more. Should it have proved fraud by Macchiarini, and had the rector then taken swift action to terminate his contract, everyone, apart from the one who committed the fraud, would likewise have benefited.

Proper regard to peer review might well have prevented Macchiarini’s rise to a prestigious position at the Karolinska. It would, sadly, perhaps not have prevented the deaths of his patients, but it would have avoided the exposure of important institutions such as the KI, the Karolinska University Hospital, and even the Nobel prize, to the crisis of confidence that they are currently experiencing.

As science celebrates its achievements this week, it should remember and cherish the system that produced them. The Karolinska scandal puts the spotlight on the adverse consequences of academic capitalism, which has robbed that system of important safety nets. A return to proper practice is needed to avoid the reputations of other important institutions suffering in the same way in the future.